Type of initiative

• Project or service
• Network
• Strategic initiative

Case Abstract

The ECS is part of the NHS Scotland eHealth strategy and part of the long-standing vision for a virtual EHR that can be accessed when it is needed for patient care in Scotland.

It should be noted that saving cash or generating cash flow is not an objective of the project. The ECS was first piloted in 2004 and launched nationally in 2006. Since then, it has grown to be a national system across all 14 Health Board areas in Scotland covering over 5.4 million patients. All of the information for ECS is currently provided from primary care GP practice information systems.

An extract from the GP patient record is sent to a national store twice a day. The dataset contains:

• Patient Demographics:
  • Name.
  • Date of Birth.
  • Address.
  • Telephone Number.
  • Patient Identifier (CHI number – a unique patient identifier in Scotland).

• Allergies and Adverse Reactions to medications.
• Medication History:
  • All Acute prescriptions in past 30 days.
  • All Repeat prescriptions in past 12 months.

• Consent Flag.
• Patient Opt-out status.

The data is then accessed by healthcare professionals treating patients outside of the GP practice. Currently, four types of care organisations have the right to access the ECS: out of hours (OOH) services, accident and emergency (A&E), the national call centre for Scotland (NHS24), and the GPs themselves. Other user groups and services have already expressed their wish to receive access to the ECS in order to ease their work and improve patient safety.

Security and confidentiality are vitally important factors for patients and clinicians. A core function of ECS is to ensure that patient information is secure and correctly used at all times by integration directly with the users clinical system, thus eliminating random searching on the database. Security is further enhanced by regular audits which check for fraudulent use.

Information is sent to ECS by implied consent from the patient. However access to ECS is only by explicit consent only and the patient must give permission to the clinician before access to ECS is allowed. GP practices can provide access to the ECS for patients by issuing print-outs when required.

There are two paths of entry to the ECS. One is a web-portal where users are required to have a specific and separate user name and password. The web services route has been developed to enable access to ECS through an interface to the users main system and does not require a separate log in or password.
All accesses made on ECS are recorded through a full audit trail that is available at all times to GP’s and Health Boards.

The system is used by approximately 9000 physicians in hospital or community centres as, well as 2600 GPs for their own practice, 1000 nurses and 200 management staff. ECS connects a wide range of different organisations: over 1000 GP practices, 20 A&E departments, 20 acute receiving units with associated pharmacists, 30 OOH organisations with nursing and medical staff, and the national call centre NHS24.