Portal Technology

Joining up information for carers and patients

April 2013 www.intellectuk.org/ healthcare

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 secure online portals and related solutions for patients, service users, local providers, and commissioners of health and care services. 1 This paper aims to provide a comprehensive summary for the health and care community on what portal technology is and can do, and how it can benefit carers, patients and providers. This paper follows on from Intellects initial portal technology overview paper published alongside the launch of the Power of Information. 2

The challenge to solve

Meeting the demands of the Operating Framework, the Quality, Innovation, Productivity and Prevention (QIPP) programme, and the aims of the Power of Information strategy will require more intelligent use of information, better integration of care and more effective engagement of patients 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 better engage 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

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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 portals provide a simple common entry point to multiple systems. Portals integrate the information held in underlying source systems and the workflows managed by these systems. Portals can also improve accessibility and navigation within source systems. Current portal solutions fall into three broad categories: Care based portals focus on a particular care need or condition by bringing together information relevant to that need or condition and supporting communication and joint working between health and care professionals, patients and carers. Examples include Renal Patient Care a patient centric portal for renal patients3 and the European-wide PALANTE project (PAtient Leading and mANaging their healThcare through EHealth).4 Organisation based portals cover the activities of a single organisation (e.g. an acute or community trust, or care organisation). Healthcare professionals and patients within that organisation and their partners 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 all health 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-trustdeliver-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

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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 and presents it in a unified and intuitive view personalised to the needs of an individual or class of users. View and do As well as integrating information the portal integrates workflows and allows a range 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 portals have 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 systems drastically 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 the functionality of portals increases. The diagram also highlights the potential for return on investment (ROI) and the relationship between increasing portal scale and use across health economies and an increase in ROI.

There are examples of view and do portals in the NHS including Royal Liverpool and Broadgreen Hospital12, and internationally at the Oslo University Hospital, Norway 13. 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

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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 Care professionals Commissioners CIOs FDs/CEOs

Education and improved engagement Audit/self service ability

Access anywhere anytime Improved decision making, co-ordinated care and a positive impact on clinical outcomes Improved efficiency

Improved information for commissioning decisions Support evolving landscape Integrate different types of information Cost saving/ smaller upfront investment QIPP Target/CQUIN target

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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 receive and those involved in their care. Basic access to test result information, pointers to relevant and trusted sources of information on a particular condition as well as recording various communications with health care professionals can have a profound impact on care delivery from the perspective of the patient and can help them to be a real part of their health and wellbeing. Data quality and self-service - The additional functions of a view and do portal can provide the possibility of amending basic personal data e.g. change of address, or booking appointments and 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 their lifestyles. Better clinical outcomes Preliminary research shows that clinical outcomes can be improved by engaging 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 help individuals navigate through their pathway, which often span across several fragmented services and care settings, providing a smoother and simpler experience for patients and their family.

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 I am ever so jealous that my renal centre is not on RPV Patient RPV is amazing I can instantly access my data and show it to my GP if I want to, it's really reassuring Patient

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

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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 through better communication and information sharing. Portals make information available in real time to support clinical decision making at the point of care and can be unrestricted by geographical or organisational boundaries, according to user needs. Improved efficiency With the reduction of duplicate data entry and far more accessible patient information, health care professionals using portal technology today find it is helping them be more efficient. Improved patient safety Through the removal of duplicate or inaccurate information together with the ability for alerts and flagging to be incorporated into the system clinicians can have increased confidence in the system. Portals also reduce the risk that often results from fragmented communication between care professionals.

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 and Broadgreen 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 the case notes I just look at the screen.17 Professor Patrick Chu, consultant haematologist at Liverpool
[The Portal] system has been invaluable to me as a lone worker, and means Im able to keep track of patients. We no longer rely on ward staff or carers to inform us about a patient being admitted. The system has helped improved communication between multidisciplinary team members.24 Suzanne Goralik, CNS, Gynaecology, Sherwood Hospital NHS Trust.

Its definitely good for Wales. We recently had an International Advisory Group (made up of healthcare experts from around the world) view the portal. It was great to see enthusiasm from people outside Wales for what were doing. Im a proud Welsh woman so anything that shows Wales off Im keen to be involved in.15 Dr. Llewellyn-Jones

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

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

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Commissioners
Improved information for commissioning decisions Portal technology brings together much of the information needed to support commissioning decisions while its use by clinicians increase the range and quality of the information available. Using the information available portals provide a platform for powerful analytic tools and commissioning dashboards to identify opportunities for service reconfiguration, target scarce resources effectively and improve health care outcomes.

CIOs
Support evolving landscape portal technology is flexible. It is able to react and change as the requirements of the care organisation or community change. Portal technology allows the CIOs to evolve their IT infrastructures, facilitating system migration, the adoption of best of breed solutions and avoiding supplier lock-in without big bang changes and minimum disruption to services. Integrate information silos portals are not limited to the types of system or information that can be integrated. By simply pulling the information from its original source without changing where and how it is stored means that all information can be included and presented in a unified view for healthcare professionals.

The solution gives our clinical users the information they need on a single screen. Everything is presented via a simple, intuitive web interface, and the information is instantly available, accurate and up-to-date. Best of all, thanks to the new wireless network, users can access the dashboard wherever they are in the hospital. Andy Thomas, Chief Information Officer, BNHFT19

[The] technology will allow us to build on this by providing a more user-friendly display, collating patient information in a summary screen in the exact way that clinicians wish to see it.20 Paul Regan, Head of EPR and IT projects at Derbyshire NHS

19 http://public.dhe.ibm.com/common/ssi/ecm/en/wsc14289gben/WSC14289GBEN.PDF 20 http://www.ehi.co.uk/news/acute-care/7414/derby-to-implement-carefx-portal

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The portal presents data from underlying systems which the clinicians 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

Id say the time difference to create new data interfaces is as much as 20 times faster than using our previous tools. Weve reconfigured the system a number of timeseach time it took a single day. If we had to do that programmatically, it would take hundreds or thousands of hours. Dave Hextell, Head of Systems Development, Heart of England Trust23

We have several major I.T. projects planned over the next few years, including upgrade of our PACS, a new maternity system and Trust-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

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

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

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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 which has 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 prescribing patterns. In addition to these potential cash releasing benefits, efficiency savings linked directly to 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 to improved integration of information, shortening waiting times as a result of increased efficiency of patient throughput as well as reducing potential risk of medico-legal liability as information is fully accessible and auditable. These concepts are explored in the benefits evaluation and realisation section. Data Quality and self-service - This can decrease administrative costs associated with episodes of care and improve accuracy of information on the care community. QIPP Target/CQUIN target portal technology does not require a large initial capital investment cost as it often builds on existing infrastructure. Portal technology also drive various efficiency savings and reduces duplication and waste within the system, providing a strong tool to help organisations meet their QIPP and CQUIN targets, while at the same time improving clinical and patient satisfaction. Information as an asset information within care settings is increasingly becoming a valuable asset which increases the more it is shared and utilised. Portal technology enables and encourages sharing information therefore leveraging information as an asset. When information 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 increasing the throughput of patients and aiding service transformation. Not only has the portal allowed us to protect our existing IT investments but it has enabled us to align ourselves with the governments 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 pilot study. Journal of Internet Research. 2011, May 26:13 (2):e41

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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 further aspects 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 a business value assessment to establish the quantifiable benefits. This can be resourced from within the organisation or working with an external partner. In order to understand the return on investment, organisations must identify relevant metrics or parameters prior to the implementation of a portal and then conduct comparative measurements before, and after implementation. Whilst this will never be an exact science, the ability to use metrics outlined in the QIPP agenda and other cost/performance improvement programmes provides 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 costs or increase income for organisations. e.g. reduction in cost for retrieving case notes from offsite storage. Financial but non-cash releasing These benefits result from savings that can be made in time and efficiency, but where it is more difficult to have a financial value attached. It is however possible to potentially derive financial value from these benefits by re-deploying staff or reconfiguring services based on efficiency savings. e.g. the amount of clinic clerk time released by not sourcing case notes and the value in increasing the amount of time clinicians have for seeing patients. Quantifiable benefit These benefits can be quantified in terms of an improvement but cannot easily be translated into financial savings. Clinical outcomes could be considered in this domain and will result in savings to the health economy. e.g. reduced emergency attendances/ambulance conveyances or the value in increasing the patient throughput in clinics. Non-quantifiable benefits (non-QB) These benefits provide value to the Trust but cannot be quantified as they relate to improvements in peoples views, opinions or feelings.

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After defining these specific parameters in these domains, organisations can conduct baseline data collection 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 expected percentage savings (based on reference sites and information available in academic literature). The cashable 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 and across organisations, key stakeholders must commit to developing and executing an effective and rigorous evaluation. (Note: This applies to any information or technology investment). This business case should be revisited periodically to track benefits realisation and evidence to extend the 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 and although 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 and clinical governance matters. For example, for out-of-area information access there will be a need for a break-the-glass capability, to allow clinicians access to people with whom they do not have a legitimate relationship. However the technology is now there to be able to do this securely and efficiently without the need for information to be moved or stored outside traditional organisation boundaries 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 the technology is available to develop this consideration needs to be taken into account when developing 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 of them 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 (and other UK equivalents). Indeed, the any qualified provider dictum, and current thinking about commissioner/provider contracts, includes references to the pivotal role of NHS Numbers in ensuring 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 the discovery 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 the Spine Mini Service development and the pre-procurement engagement with the industry on the development of Spine2 to address this and will continue to work with the team to improve this in future.

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In this instance, organisations may also consider the use of specific technology to aid accurate patient identification across boundaries. The specific technology that can assist organisations in managing 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 quality and this must be closely monitored. The information presented in the portal is only as good as the data available in source systems. Organisations must be prepared to work hard to improve their data 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 makes the 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, implementation project managers and suppliers are now more used to this challenge, and experience shows that they 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 organisations applications and medical devices, automating the routing, customisation and transfer of data. New services or organisations can be quickly added. Some integration engines can serve as an enterprise integration engine, a local integration engine or just as the interface between the Portal and the surrounding applications. Some portal solutions have the capability to link into existing integration engines deployed by the client. It is critical that organisations understand their specific requirements and use cases as this will drive the type of integration approach. Exploiting data - While integration engines provide various techniques to extract data from underlying systems in to a portal this process would be much facilitated if underlying systems exposed API which allow 3rd party application to read and write to them and programmatically manage associated transactional services. It is likely to be difficult to get APIs developed on legacy systems that are no longer in active development but it should be possible where this is not the case. In many situation NHS purchasers may wish to extend contracts for or re-procure existing systems and they should take such opportunities to insist that in return for extended business that the 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 that extend the functionality of the portal and to this end the vendors of portal should be encourage to expose APIs within the portal both to access portal data and functions, but also potentially as a more convenient and cost-effective way for third parties applications to interact with underlying systems. Record location - Record location will be a key requirement, so that records for people outside the caring organisations normal geographical area can be located and information retrieved, subject to agreed information governance rules. The technology already exists, in use in the US, and is to be rolled-out in Southern Scotland. In the US and Scotland this works on the basis of the Integrating the Health Enterprise (IHE) standard.29 A record locator service further enhances the functionality of a portal by streamlining the queries of source systems. Standards - The industry agrees that standards are a good thing but it must also be noted that they can be a barrier to both rapid progress and innovation. We would recommend ensuring that portal solutions 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 the starting point.
29 http://www.ehi.co.uk/news/acute-care/7251/leeds-releases-portal-open-source-code

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Business change/cultural change - Portal technology has the possibility of revolutionising the way an individual care setting, team or community do business as usual. Only by making changes to clinical practice and procedures generally can the significant benefits be realised. Therefore, it is vital to do 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 of technology so the initial buy-in hurdle is no longer a real issue but they must be engaged throughout to ensure they understand how best to reengineer what they are doing to fully utilise the tool in a care setting. The centre should work with industry to identify standards around portal approaches. A true portal approach does not replicate data, but provides a view of data that exists in underlying systems. This approach satisfies multiple Information Governance considerations and thereby represents a more flexible and scalable model. This is important to consider when working across health 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 Northern Ireland: Scotland: A comprehensive survey of all care professionals in NHS Scotland was conducted in order to elicit what types of information should be available through portals. This resulted in the buy-in of clinicians, general support for the idea of using portal technology to make information available to support more efficient healthcare delivery and to improve patient safety, 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 was implemented, 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 the pitfalls of reinventing wheels, and make an easier start in implementing their own portals, whether wholly within organisations or across organisations.

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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 through EHealth).31 The Norwegian component is a pilot to look at giving patients wider access to their records and to help those with long term conditions manage them through access to specialist tools. It will involve 55,000 users spread over SE Norway, 5000 of these users are for the chronic conditions 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, Alton and Bordon, as well as surrounding towns and villages in north and mid Hampshire and west Berkshire - portal integrates the clinical five: patient administration system that integrates with other systems and provides sophisticated reporting; a system that manages order communications and 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 integration services provider, connecting five systems: iSofts PatientCentre PAS; the trusts own Patient Pathway Manager, which is used in the trusts oncology department, and information from applications provided by Bluespier, Ascribe and EMIS. Northumbria Healthcare NHS Foundation Trust34, went live with a clinical portal from Orion Health in Nov 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 presenting pathology and radiology reports, PACS images and discharge letters. Oswestry - a very long standing development (13 years), that started with a clinical audit requirement, and has been developed to meet the specific needs of the local healthcare community. Royal Liverpool and Broadgreen Hospital 35, after a proof of concept exercise, now rolling out CSC/Harris clinical portal, using an interoperability product that provides a single view of data from different systems - based on the Harris s Fusionfx interoperability platform and is currently drawing information from the trusts core clinical systems, such as the iPM PAS and Sunquest ICE electronic results reporting and requesting. West Hertfordshire36 Making things work better encompasses overcoming numerous systems, different suppliers, multiple logons and convoluted workflows - results in significant improvements to clinical efficiency and patient journeys, and ultimate collaboration across health and care in the region. The West Hertfordshire portal is based on the Harris Provider portal and Fusionfx interoperability platform. Worcestershire - Worcestershire Acute Hospitals NHS Trust also went live in Nov 2011 with a clinical portal from Orion Health - the key foundation for creating an integrated electronic patient record.
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-portal 34 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

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Community based Colchester - lack of integration between trust systems means is cumbersome for clinicians to use and there is still considerable reliance upon paper records and manual re-keying of data - plan is to buy 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, 000 documents per week (results, letters, pre-op assessments, etc), and more recently Theatre Session lists - integrates seamlessly with the new Trak implementation at IRH using patient context. Heart of Birmingham PCT - aggregates information from existing systems across its healthcare community to present a single, integrated care record at the point of care, using Graphnet technology - allowing GPs and other care givers across Birmingham to gain access to radiology and pathology 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 Fusionfx interoperability platform. The solution pulls data from multiple underlying source systems and presents them in a clinically intuitive unified view, leveraging Master patient index (MPI) and record locator service (RLS) technology. Wales - still at the pilot stage, with national roll-out planned - using Scottish SCI Gateway (also used 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 more widely roll out the McKesson Care Portal in 2013 to provide local GPs with real-time access to information held by the hospital in its Medway Electronic Patient Record. This will include information on patient admissions and discharges, test requests and status, and wider hospital news38. Colchester Hospital University NHS Foundation Trust - plans to pilot the McKesson Care Portal in 2013 to provide a clear, coordinated, view of Medway PAS information that local GPs can use to improve the patient experience and quality of care39. Whittington Health NHS Trust - in 2013 plans to pilot the McKesson Care Portal to provide a view of Medway PAS information that local GPs can use to improve the continuity of care. The McKesson Patient Portal will also be piloted to provide patients with easy access to heath care information about 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 chronic disease 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 i2010 Sub Group - part of this activity is about standards. Oslo University Hospital, Norway41. Oslo University Hospital project has approximately 20,000 users who are spread across 40 sites. The hospital constitutes about one third of the healthcare provision 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

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Rikshospitalet the largest cancer hospital in Norway42. Rikshopsitalet is the national hospital of 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 the accumulation of premises and centres. At the time it had 8,000 users, and was spread geographically in multiple hospitals, treatment centres across the city and in addition across a number of locations within the Oslo county. The Portal solution has been in operation since October 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 consumeroriented portals to access the PCEHR System - provider portals link information for direct healthcare purposes - a host of standards requirements will ensure that the system works.

About Intellect
Intellect is the trade association for the IT, telecoms and electronics industries in the UK. Its 870+ members account for over 80% of these markets and include blue-chip multinationals as well as early stage technology companies. Intellect is a not-for-profit and technology neutral organisation. Intellect Healthcare Programme Mission to develop the UKs capability to support a strong and growing information and technology industry operating in the health and social care sector to work with policy makers, decision makers and practitioners to facilitate the delivery of improved health and high quality care for all enabled by information and technology to provide a collective voice for over 290 member companies operating in the health and social care sector to maintain the industrys reputation and champion its strategic importance to our stakeholders to use our expertise and knowledge to provide the highest quality of service and intelligence to our members in the health and social care sector, helping them to make the right business decisions to drive growth and profitability Our members cover areas such as hardware, software, applications, telecoms and medical devices and offer solutions across the entire health and social care sector. Visit our webpage for further information www.intellectuk.org/healthcare For questions or comments regarding this response please contact: Jon Lindberg Associate Director Healthcare Programme T 020 7331 2021 E jon.lindberg@intellectuk.org

Thanks to...
The paper was prepared by Intellects Healthcare Programme. Intellect wishes to thank all Intellect members who contributed to this paper, and particular thanks go to the following people for their valuable 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

Portal technology - joining up information for carers and patients

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Intellect is the voice of the UK's technology industry. We believe that a vibrant and successful technology sector is vital to the long term economic well-being of the country. Our business services help companies of all sizes compete and innovate in a dynamic global market. We represent the views of industry to government and regulators and also provide opportunities for government and regulators to interact with industry on key policy and market issues. Our mission Make the UK good for TECH Work to ensure that the UK is the best place in the world for technology companies (both domestic and foreign owned) to locate and grow Make TECH good for UK Work to ensure that the full economic potential of technology is harnessed right across the economy Make TECH good for UK people Work to ensure that technology is used to improve and enhance the quality of life of all consumers and citizens

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Intellect Russell Square House 10-12 Russell Square London WC1B 5EE T 020 7331 2000 F 020 7331 2040 E communications@intellectuk.org W www.intellectuk.org Intellect April 2013 The information in this paper is for use and dissemination on the condition that Intellect is referenced accordingly.