Create your own eConsult eHub

You can either use an Electronic Care Record Sharing (ECRS) system which provides the eHub with access to the practices records or you can provide the ability for your eHub clinicians with access to each site.

Choose a system that meets your ECRS systems capabilities or desired model:

Use Electronic Care Record Sharing (ECRS) system

Implementing an ERS system providing eHub staff access to all patient information across multiple sites through one login and a Data Sharing Agreement

Considerations:

• Do your practices use the same GPSoC system, i.e. EMIS/SystmOne/Vision?
• All practices will need to be using the same patient records system for an ECRS to work.
• Does your ECRS system provide access to a patient’s full record?
• The eHub clinician will need to be able to fully view a patient record to appropriately treat a patient and complete an eConsult.
• Does the ECRS system allow for electronic prescribing?
• The eHub clinician may need to issue a prescription to appropriately complete an eConsult.
• Does your ECRS system allow relevant users to add consultations to records?
• The eHub clinician will need to and add to a patient record to appropriately complete an eConsult. Is it a read/write directly in to a practice or is it just a viewing record only?
• Does your ECRS system allow relevant users to book appointments?
• The eHub staff may need to arrange a face-to-face appointment as further investigations may be required.

Provide eHub staff access to each site individually

Implementing a process for your eHub clinicians to access each practice’s electronic records system individually and directly (including smartcard access)

Considerations:

• Do your practices use the GPSoC system, i.e. EMIS/SystmOne/Vision?
• eHub staff will need to know how to appropriately use each system used by the practices.
• Do you need and therefore have the ability to restrict the access the eHub staff have on your patient records system?
• It is not appropriate for eHub staff to have access to patient and practice information which does not affect them.
• How many practices will the eHub clinician cover?
• The eHub staff will need login details for each practice, an appropriate amount of log in access per eHub staff member will need to be agreed for them to realistically comply with the IG login requirements.
• You will need to draft a bespoke Data Sharing agreement and standard operating procedures to ensure safe operations.
• This is essential to ensure compliance with IG. The larger the number or practices the harder it will be to ensure buy in.

You can choose either: a workflow system where eConsults go directly to practice, with the eHub picking up appropriate eConsults; or a system where eConsults are directed to your eHub, with the eHub passing back appropriate eConsults (if required). Both options are available to you regardless of the ECRS system you have.

eConsults go to practice. eHub picks up appropriate eConsults

Considerations:

• Could this affect the response time?
  • Need to consider timeframe on this process as it is possible for an eConsult to wait in two separate workflows, one after the other.
• Who will be responsible for allocating eConsults to the practice staff / eHub?
  • This can be managed by an administrator at each practice or the eHub can pull the eConsults to be completed by them
• Will administrative eConsults remain within practices and clinical eConsults go to eHub?
  • Admin must be provided with appropriate training and responsibilities. Who will process clinical administrative requests i.e. MED3s
• Who will respond to the patient?
  • Practice / eHub team? If a response or further action is needed e.g. to pick up a prescription is a task sent to the admin team at the site or the eHub to action
• When is the cut off for eHub delivered eConsults?
  • Practice and eHub opening times may differ. Will there be a cut of time or a set allocation for practices?
• How will you construct your appointment book?
  • If practices can book in eConsults to the eHub via a shared appointment book should there be a reciprocal booking arrangement for face to face appointments at practices?
• How will uniform processes be managed across all practices and eHub?
  • Monitoring of processes and outcomes is vital. How will you ensure that every practice follows the same process? Multiple processes will lead to confusion for eHub health professionals.
• Disaster planning
  • In the event of a disaster can the eHub support the practices / will the practices support the eHub? Clinical & Information governance responsibilities

eConsults go to your eHub. eHub passes back appropriate eConsults if required

Considerations:

Could this affect the response time?
Need to consider out of hours scenarios or different opening times of practices. Do you want to set an ambitious response time i.e. 2hours?

Will you need an administrator to manage eConsults coming through and correctly allocate to eHub staff / practice?
Admin must be provided with appropriate training and responsibilities. Staff will need direct links and a good relationship with local practices

Who will respond to the patient?
Practice / eHub. If inviting patient for a face to face how will this be done? What about admin eConsults – will they be work-flowed back and how. Will you use cross organisational tasks/email/direct telephone.

How will uniform processes be managed across all practices and eHub?
Monitoring of processes and outcomes is vital. How will you ensure that eHub processes are embedded in a practice that will have little to do with the administration and processing of eConsults

How will practices “see” the activity and benefit you are providing?
How will practices see and feel the benefit of the eHub if they do not see the workload impact? Should you create a report or dashboard to feedback

Disaster planning
In the event of a disaster can the eHub support the practices / will the practices support the eHub? Practices will need to remain adequately trained on managing eConsults within practice. Clinical & Information governance responsibilities

Create along with the desired workflow across sites.  Using the above information and relating it to what is possible with your practices you will need to develop the following policies:

• Deployment plan: Who, where, how. Big Bang or phased. Communications strategy. Practice engagement. Training
• Change Management: Incorporating this across multiple sites, who to target for utilisation, communication to patients and staff
• Administrative and clinical processing of eConsults: to include prescribing across sites, admin eConsults, consultation processes, arranging face to face appointments, responsibilities etc.
• Information sharing across sites: (privacy impact assessment- data sharing, fair processing, implied vs implicit consent) raising concerns, progress updates, etc.
• Monitoring of eConsult pathway: are response timeframes being met, are eConsults being allocated appropriately.
• Allocation of responsibilities: Overall responsibility for eHub, staff training, monitoring, assessment of processes and reaching targets, ensuring uniform policies followed across sites etc.
• Clinical & Information Governance: who holds responsibility, monitoring, access, requirements, etc.
• Supply vs demand: staffing requirements, patient usage, etc.
• Risk Management Plan: staff shortage at practice/eHub, access across systems failure, eConsult lost in pathway. etc.

Here’s who to contact for guidance and support:

• Patient records system – your patient records systems provider
• Information Governance – your SIRO, Caldicott Guardian and/or Data Protection Officer
• Clinical Governance – your clinical governance lead