YAS receiving outcomes from transfer of Care to ED's

This was one of the original Phase 1 Use Cases. It is contained within the attached document, and the rationale, benefits etc are detailed below.

1.1. Use Case Definition

· Ambulance Handover Transfer of Care

Description

Upon arrival at an Acute Emergency Department, ambulance crews use the Trust’s EPR software to finalise a transfer of care document that details the patient’s:

· Identity and demography

· Social and familial history

· Presenting complaint

· Vital signs

· Any observations and/or examinations undertaken

· Any care and/or medication that has been administered

The narrative covers the period from the time the ambulance attended on scene to the point of arrival at the ED and, once finalised, the document is made available to the receiving Emergency Medicine clinical teams.

This process forms part of what is known as an “Ambulance Handover”.

Problem

The transfer of care information is captured electronically and is available digitally. Currently, however, the method of dissemination is via a standalone web portal and involves ED staff to login, search for the patient and view the associated transfer of care document. ED staff can, if they wish, download the documentation and attach it to the corresponding patient record in their own local systems. This is time consuming to staff insofar as:

· There is a requirement to access and logon to a separate system.

· There is a need to find and retrieve the patient’s handover documentation.

· The handover must be downloaded and then maybe printed and scanned prior to manually attaching/uploading it to the patient’s record.

These activities may have an impact on the delivery of patient care as the information is not available to the right staff at the right time.

Proposed Solution

The pilot wishes to explore the possibility of sending the transfer of care directly from the YAS EPR software (the data provider) to the receiving organisation (the data consumer) using the YHCR componentry.

It is proposed that the transfer of care document, once finalised, will be transmitted to the receiving organisation as a self-contained FHIR composition resource. This composition will adhere to the current document structure and content as available in its current form (at the time of writing). Should an organisation not be in a position to receive a FHIR composition, then it is proposed that the document is sent as PDF and, even in this form, it will be sent across the YHCR componentry.

The solution will only afford pilot organisations with the ability to transmit the document between local YHCR components. Therefore, the way in which the document is made available by the data consumer is a decision that will be devolved to the appropriate team(s) within each organisation acting as a data consumer and is outside the scope of this proposal.

Acceptance Criteria

In order to determine success, the following acceptance criteria must be successfully met:

· The transfer of care document is generated for the correct patient.

· The transfer of care document contents is an exact copy of the finalised EPR record.

· The transfer of care FHIR Composition and PDF replicate the current structure and content “as is” and is clinically signed off.

· The transfer of care document is delivered to the correct destination.

· The destination is able to match the transfer of care document to the correct patient record using the patient identifier(s) present within the composition.

· Secondary Care ED Discharge Disposition Outcomes

Description

Secondary care systems offer a choice of coded options to describe how a patient’s ED attendance ends (the attendance disposal). For instance, a patient could be admitted as an inpatient, be referred to a fracture clinic or pass away. This information is imperative for the ambulance service to understand the effectiveness of the care provided to the patient when on route to hospital.

Problem

The attendance disposal reason is captured electronically by all secondary care organisations that provide an emergency and/or urgent care service. It is mandated by the core NHS commissioner data sets and is submitted to the department of health on a monthly basis as part of the CDS A&E data return.

With no explicit link between the ED attendance and the EPR record, there are difficulties in linking the datasets together. Moreover, the Ambulance Service do not have access to the CDS data that is submitted by the secondary care providers in the YHCR footprint.

Proposed Solution

The pilot wishes to explore the possibility of receiving the finished ED encounter directly from the secondary care service’s system. It is proposed that this is achieved using the subscription mechanics afforded by the YHCR componentry whereby:

· A Subscription resource is lodged against each secondary care service.

· The subscription would be triggered in accordance to an agreed set of criteria which could be, for instance, for when any emergency Encounter that has an arrival mode of ambulance is disposed/closed.

· Once triggered, the subscription would send the Encounter details to the YAS YHCR componentry.

The solution will only afford pilot organisations with ability to send data using the Subscription/Notification mechanism between the regional and local YHCR components. Therefore, the way in which the Encounter data is consumed and linked to the corresponding EPR dataset is a decision that will be devolved to the appropriate team(s) within YAS.

Acceptance Criteria

In order to determine success, the following acceptance criteria must be successfully met:

· An ED Encounter resource is sent to YAS if, and only if, the Encounter exactly matches criteria given in the Subscription.