The Acute Trust will probably upgrade current OASIS PAS (Patient administration System) to eOASIS over the next few months
This will give them to capability to do electronic discharges.

Points to consider:
Electronic Discharge letter contents:
Integration into the Hospital workflow:
Communicating to the GPs:

Electronic Discharge letter contents:

• Initially generic for medical patients
• Finding out the template another Trust with eOASIS uses to see if fits our needs, as this would save a lot of work (DOAS)
• Seen demo, PAS upgrade could happen by Jan09 with a demo area before this so the background configuration can be done beforehand.
• Once we have a copy of their template, share with GPs and then get feedback.
• This may be the easy part
• If the contents is accurate then that's a great start as it wil at least be legible.
• There are National Standards for this, including the coding SnomedCT/Read, XML/HL7 code/structure (this is for the techies to ensure is upto standard).
• We should aim for good coding such as diagnoses etc..,so that GPs can then code data from the letter into the GP systems accurately.
  

Integration into the Hospital workflow:
PAS:

• To make it practical for clinicians to complete the discharge letter, much of the letter's content will need to be extracted from PAS, so that the HouseOfficer is not typing up everything as the patient is leaving.
• Patient Demographics
• Clinical team
• Diagnoses
• Unfortunately PAS data is not complete/reliable at present
• I think that most BSUH clinicians would welcome a driver for more accurate live PAS data, as other improvements are also dependant on it.
• There was a statement that this only happened at another PCT when the CEOs felt that Live accurate Hospital PAS data was such a priority that they set a deadline for (Electronic) discharge summaries after which there were penalties.  I'm sure we can get electronic discharge letters without this.
  

Pharmacy:

• Live integration with the Pharmacy IT system would be ideal
• So that the actual details of the patients meds are fed live into the letter.
• Not integrated at present, may have to work around this.

Communicating to the GPs:

• Fax/post - The Acute Trust may be happy with this as it would still satisfy the contractual arrangement,.
• NHSMail - another option, but do we want our practice emails filled with letters not automatically associated with Patient records (though we could test this approach with a practice setting up a practice NHS.NET email, receiving the letters, so far not popular with many GPs).
• Pathlinks - sending letters this way sounds better if we can get the process right, especially as all practices are all ready setup with and understand this system.
  
• Another solution similar to Pathlinks that may encompass other modalities eg Radiology reports?. ?Funding.
• I would like some advice as to whether a Pathlinks-type solution is the right way to go, or if there is a better solution?
• If we used Pathlinks, what happens regarding Coding?.
• Is there a solution where NHS mail can automatically link docs to the GP patient record?.

Probably piloted on one ward initially to get it right.

Questions from Steve Barden and the Steering group:

"What details are required for an electronic solution.
Obviously an electronic discharge summary could contain much more than what a hand written form can.
It is therefore important that those of you from primary care can provide us
with what additional information would be appropriate.

I cannot emphasise how important it is to have primary care input throughout
this process."
Please login and see the SIGN & RCP attachments below and add to the comments.

GP requirements list being discussed:
We are collecting requirements for the recent HIS Project manager Tim Moore.
The team on the PEC and PBC are pushing to get timeframes and help drive forward this project to get the proper attention and funding.
As there are many systems and ways of working in the diverse practices,
I think we should try to describe how the process should generically function.
Separate from the potential named solutions.

Essential requirements:  please add to and comment on these
such as:

• Electronic (obviously).
• Transmitted safely to the correct practice.
• uses NHS number as unique patient identifier
• Quick and simple.
• Easy to Organise.
• compatible with a system of easy integration into GP software
• Equitable (system should ensure certain practices are not disadvantaged - I think you mentioned this one and the next, Tim)
• When
  implemented should be presented almost "fait accompli" (I think in this
  instance {correct me if I'm wrong} Tim means as a done deal without
  lots of individual configuring needing to be done by each practice,
  unless done for them by the HIS/PCT).
• In line with National Standards ( the group has the SIGN and RCP draft guidelines for the content).
• capable of recording and transmitting minimum standards of information
• As future proof as is possible in view of Medium and Longterm Solutions.

Debatable: Probably good practice

• Coded eg Diagnosis, Investigation, F/u, Meds?
• Associated with the Patients Unique identifier in the GP system.
• Auditable
• Able to be sent to a different practice if arrives in error.
• etc......

Please comment