Scottish National Users' Group (SNUG) Podcast

A National Digital Platform for Scotland

The National Digital Platform (NDP) is an open technology platform developed by NES (NHS Education for Scotland) in collaboration with multiple partners from across health and social care. It aims to make it simpler to deliver technology that improves the care and well-being of people in Scotland. The platform brings together cloud-based digital components and services to provide technology solutions for the public sector in Scotland. It offers a range of technology services, including an identity management service, application programming interfaces (APIs), and an application development framework.

In this episode, we find out more from Dr Paul Miller, who is the Clinical Informatics Lead at NHS Education for Scotland Technology Service, a working GP, and also the Co-chair of the openEHR Clinical Program Board. Paul has been a long-term member of the National Vision Users’ group and Primary Care Informatics / SCIMP, before working for the NES Technology Service. We discuss the changes in general practice, the concept and development of the National Digital Platform (NDP), the electronic ReSPECT application, what the migration challenges are, the need for coexistence with commercial systems, and the importance of incremental change in transforming healthcare systems. The shift toward separating data from applications and adopting digital health platforms will be a long-term, iterative process and require strong clinical leadership.

The ultimate goal is to design services around patients rather than around healthcare systems, allowing patients to access and manage their own data.

Any feedback or comments are welcome via email: andrew.mcelhinney2@nhs.scot or alex.defranco@phs.scot . Paul Miller on X/Twitter: @docpaulmiller.

National Digital Platform - The open technology platform for Scotland

Video explainer on the Digital Platform from Digifest 2022

ReSPECT and Open EHR video from Digifest 2022

The ReSPECT process

Scotland’s Digital Health and Care Strategy

SNUG Annual Conference and AGM November 2023

Discussing digital transformation with Prof Bob Wachter

We are delighted to welcome Professor Bob Wachter in this episode of the SNUG podcast.

He  is Professor and Chair of the Department of Medicine at the University of California, San Francisco (UCSF), a highly influential voice in the worlds of medicine and Health IT, renowned for his book "The Digital Doctor"and the 2016 Wachter Report on NHS digitalization. He joins us to discuss a wide range of current topics, including the future prospects for healthcare, with a particular focus on the impact of digitalization, consumer expectations, and the balance between technology and human interaction in medicine.

We discuss the trends in both US and UK in terms of digitalisation, increasing demand for health care, and the impact of technology on doctor-patient interactions, as well as the rapid advancements in AI, and how healthcare delivery may be reshaped in the future.

We look at issues of trust, bias, and the potential consequences of over-reliance on machines, including “automation complacency”. And finally, we explore the dynamic use of social media, particularly X/Twitter, in combating misinformation during the COVID-19 pandemic. Professor Wachter discusses his social media journey, emphasizing the role of trusted voices in providing reliable information during crises.

Any feedback or comments are welcome via email: andrew.mcelhinney2@nhs.scot or alex.defranco@phs.scot

You can subscribe to the SNUG podcast on the following platforms:

SNUG podcast on Apple podcasts     SNUG podcast on Google podcasts    SNUG podcast on Spotify

NHS Digital Academy

Robert Wachter on The Digital Doctor

Bob Wachter's Viral Tweet and Thoughts on AI in Medicine

A Fireside Chat with Eric Topol

ChatGPT: Will It Transform the World of Health Care?

UCSF Department of medicine videos on Youtube

In the Bubble podcast - The Doctor Can't See You Now (with Dr. Christine Sinsky)

Prof Bob Wachter on X /Twitter @Bob_Wachter     SNUG on X /Twitter @SNUsersGroup

Digital asynchronous collaboration – using Engage

In this episode, we return to the world of Digital Asynchronous Consulting Systems (DACS) and ponder how digital changes might be implemented in general practice during a time of chaos for the NHS, as it has its 75^th Anniversary.

We get a fake 5-year old’s opinion on DACS systems, before hearing from Michael Wong and Sandeep Singh from Engage Health Systems, who have developed a system called Engage Consult, a digital asynchronous consultation system (DACS), which is already in use in England but is new to Scotland. We covered the following ground in the conversation:

• Why is Engage Consult a configurable digital asynchronous consultation system (DACS) that can be tailored to meet the specific needs of healthcare practices?
• How is collaboration with other services facilitated?
• How can implementation vary based on organizational structure, such as Primary Care Networks (PCNs) in England or a more practice-level focus in Scotland?
• What are the automation features for intelligent routing and assignment of patient requests?
• What is the integration with Vision and EMIS PC?
• How much will the system cost?
• How are implementation and support approached?

Video demonstrating the Engage Consult system from the SNUG Members Day 2023 (log in needed)

Engage Health website

Technology Enabled Care explainer on DACS systems

The birth of the NHS

Summertime Blues – the Who

Unveiling the potential of AI in general practice

In this episode, we delve into the fascinating world of some of the new AI tools and their impact on healthcare and innovation. We explore the advancements in large language models like ChatGPT and the potential they hold for transforming the way we access medical information and provide care. We discuss the experiences of Dr Keith Grimes, an expert in digital health and innovation, as he shares his insights from working at Babylon and his own consultancy.

We unravel the main points, such as the importance of detailed instructions and questions for obtaining accurate results from language models. We touch upon the challenges and benefits associated with relying on AI for medical information, emphasizing the need for critical thinking and background understanding of medical concepts. Privacy considerations and the global access disparity in healthcare are also explored.

Join us as we navigate the promises and concerns surrounding language-based tools, shedding light on their potential to revolutionize healthcare while navigating the ethical and practical considerations. Get ready to expand your knowledge and gain insights into the future of healthcare in the age of AI.

Dr Gandalf and Keith Grimes discuss and demonstrate ChatGPT video: ChatGPT in healthcare

UCSF debate on Chat GPT in healthcare chaired by Bob Wachter video: ChatGPT: Will It Transform the World of Health Care?

The Wachter Report: Making IT Work: Harnessing the Power of Health Information Technology to Improve Care in England 

GreatAIprompts.com

The AI Revolution in Medicine: GPT-4 and Beyond

Dr Keith Grimes contacts: www.curistica.com
Linkedin: https://www.linkedin.com/in/drkeithgrimes/

Twitter: https://twitter.com/keithgrimes

Register for the SNUG Member’s Day May 2023

Making the Right Decision

High risk medicines are defined as medicines that have a high risk of causing injury or harm if they are misused or used in error. Error rates with these medications are not necessarily higher than with any other medicines, but when problems occur, the consequences can be more significant. A number of high risk prescribing safety indicators have been identified.

We talk to Dr Ann Wales, @Ann_Wales who is the Programme Director for Knowledge and Decision Support at the Digital Health & Care Innovation Centre, and she manages the National Decision Support Programme and its Right Decision Service.

We also hear from Dr Scott Jamieson, @DocScott82 a GP in Tayside and member of RCGP Scottish Council, who is one of the most enthusiastic GPs in Scotland and has an interest in Quality Improvement, among many other things. He has tried out the Right Decision Support tool which alerts prescribers to potentially harmful combinations of medications, using algorithms triggered by specific conditions, patient age, and values like blood pressure and renal function. All the GPs who have tried out the tool so far want to keep it!

Anyone who is a prescriber will be interested to hear more about this useful new tool, which will be made available across Scotland soon.

The DQIP study

Scottish Polypharmacy guidance

Right Decision App library

BJGP paper with high risk prescribing indicators (table 2)

Sign up for new Bing powered by ChatGPT

The Bing who loved me – NY Times Hard Fork podcast

In hours activity data, books and Chat GPT

How can we best measure the activity in general practice and measure how busy we really are?

The In-Hours GP Activity project is a collaboration between National Services Scotland (NSS), Public Health Scotland (PHS) and the Scottish Government to access, understand and improve the availability and consistency of activity data from in-hours general practice. A pilot was held during the autumn of 2022 to try out guidance to practices on encounter recording, collect data and try out a dashboard at practice level.

Numbers of “encounters” as recorded in the practice clinical systems and the corresponding “healthcare professional role” responsible for the encounter are made available as a by-product of documenting routine clinical care. Recording behaviour varies across and within practices, and to extend the project to cover all practices will require more work following feedback gained during the pilot. In this episode we have an interview with Dr Keith Moffat and Billy Davidson of NSS, who discuss the encouraging progress so far and planned next steps.

We hear from our friend of the podcast, Dr Chris Weatherburn, for his annual dose of inspiration and book recommendations. This year it’s all about Resilience, how to create new and sustainable habits, and being surrounded by idiots!

And finally at the end of a bumper episode, we note the emergence of a new level of “smarter” AI Chat GPT (Generative Pre-Trained Transformer), which uses deep learning algorithms to analyse and generate text, with some amazing results. We discuss it rather briefly but do manage to create a poem about a famous doctor from Dundee, and a limerick about SNUG!

Primary Care - In-hours General Practice Activity Visualisation

Dr Chris Weatherburn video review of Resilient by Rick Hanson and Surrounded by idiots

https://chrisweatherburn.com/smart-change-five-tools-to-create-new-and-sustainable-habits-in-yourself-and-others-by-art-markman/

ChatGPT  DALL-E2

Learning about system change at the SNUG conference

Our recent SNUG annual conference on the 30^th November, was held face to face for the first time in over 3 years, at the Westerwood hotel in Cumbernauld. In this episode we get a taste of the atmosphere at the conference and say hello to some of the attendees. The main focus for many people was the forthcoming GP system change, with every practice now planning a move to Vision over the couple of years.

We have edited highlights of a workshop which was really useful in setting out what practices will need to think about before they embark on the task of changing systems, especially important for EMIS practices, who will have to move to a brand-new system, requiring much preparation and re-training.

We hear hints and tips on what to do from Robin Cupples, and Dawn Ellis, GP IT facilitation managers with the NSS Re-provisioning team, and Dr Jim Campbell, former GP and clinical advisor to the national team.

What you can do now?  Deal with your patients that are registered for patient access; register for the Cegedim elearning; find and replace any local codes; tidy up your user list; think about what third party tools you need to use; and consider data cleansing.

Plan ahead for the migration period:  appointment books, data entry and Word / mailmerge templates and searches don't migrate, so those will need to be rebuilt in the new clinical system. Data validation and data mapping will be needed for the first cut of migrated data.

Plan for the Read- only period: let the patients know at a suitable time; plan for how clinical notes and prescriptions issued during downtime will be recorded; consider how will you manage when lab results and screen messages are switched off (just before the final cut of your data is taken).

Plan for Post migration: there will be training days and webinars. Clinical data will need to be re-entered, including allergies.

And we hear from Alex De Franco, the SNUG Business Manger on how she thought the conference went.

Contact the Re-provisioning team at: NSS.GPITRe-provisioniong-Scotland@nhs.scot

See the latest migration news at http://gpit.scot.nhs.uk (NHS net only)

Register for the Cegedim elearning Zone for videos and demos of Vision

Re-provisioningcast

And then there was one….

EMIS Health shared the disappointing news this week that they are unable to meet the timelines of the Scottish Framework for GP IT Re-provisioning, and as a result, have made the decision to withdraw.

This will leave Vision as the only accredited GP system for Scotland.

A Frequently Asked Questions (FAQ) document regarding EMIS’ exit from the Framework has been created and issued to health boards. The NSS GP IT website (NHS net only) will also be updated to reflect the changes announced. If you have a specific question about EMIS, please contact your local Facilitator Lead or eHealth team, or contact the programme team at nss.gpitre-provisioning-scotland@nhs.scot.

In this edition of the SNUG podcast, Drs Andrew McElhinney and Neil Kelly discuss the implications of the news for Scottish GP practices, and manage to come to a reasonably positive conclusion, while accepting that it will take a massive amount of work by boards and practices to manage a system migration for more than half of Scottish GP IT Users over the next couple of years.

If you aren’t already a SNUG member, see our website below for more information about SNUG, its support for GP practices in Scotland and the forthcoming November conference.

https://www.snughealth.org.uk/snug-conference-and-agm-2022-november/

SNUG conference registration page

Mindtools: coping with change

The End by the Doors

Docman – current problems and future developments

Docman is an electronic document management system and is used by general practices across Scotland. It was integral in the move to paper light practice and provides a workflow functionality, as well as rapid transfer of discharge and clinic letters and results from hospitals via the Docman hub and electronic document transfer (EDT). Using electronic document interchange between practices, the GP2GP process has been developed to transfer patient records rapidly when they change GP practices.

We hear from Sharon Wishart, who is the lead facilitator at the Primary Care Mentor team in Fife, and we discussed her experiences with Docman  over the years, as well as dealing with a recent national problem with mysteriously disappearing documents. We also have highlights from a workshop on Docman 10 at the recent SNUG Members' Day given by Sean Foster, Philp Austin and Lesley Thorpe from the supplier company, OneAdvanced, when they outlined some of the benefits of Docman 10 over Docman 7. Docman 7 relies on local servers, but Docman 10 is run on a web browser as the data is stored in the cloud. Backups and updates will be handled in the data Centre, no down time is needed by practices and speed will be consistently better even at branch sites. Remote working will be easier, and also federated working.

SNUG members asked the team questions regarding coding of documents, system speed, SCI Gateway integration, timescale for rollout, direct printing to Docman, joint folders, updating the National folder structure, and emailing documents from Docman.

Oneadvanced Docman 10X

Docman - Electronic Document Management for healthcare video 2011 

History of Docman 

National Docman Conferences 2016 highlights

Discussing the digital strategy

Scotland’s Digital health and care strategy was published in October 2021: https://www.gov.scot/publications/scotlands-digital-health-care-strategy/

What are we going to do with citizens data, with the management information that is collected, how do we address the challenges of devices and new sources of data that are coming in, how do we build trust?

In this episode, we hear highlights from a plenary from the May 2022 SNUG conference given by Jonathan Cameron, Director of Digital Health and Care at the Scottish Government.

There are three strategic aims:

1. Citizens to have access to, and greater control over, their own health and care data
2. Health and care services to be built on people-centred, safe, secure and ethical digital foundations
3. Health and care planners, researchers and innovators to have secure access to the data they need.

Jonathan explained how these aims are being taken forward, with an emphasis on how they apply to Primary Care and general practice in Scotland.

Views are also sought on the new Data strategy which is out for public consultation until August 12^th.  

Data Strategy for health and social care

Contact via email: HSCDatastrategy@gov.scot

TURAS learning site: Digital Health and Care - Supporting development of a digitally skilled workforce