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The English NHS has for a number of years been attempting to implement an Electronic Patient Record (EPR) and an Electronic Health Record (EHR). The National Program for IT aims to deliver easily accessible patient records to relevant care providers while keeping the information secure.  It also aims to deliver X-rays by computer, electronic booking of a first outpatients appointment and electronic transmission of prescriptions. (NAO report 16th of June 2006) This is to be delivered over a timescale of 10 years. The NAO claims that areas of this program are on track.  However the areas “on track” are the simple things relating to infrastructure such as networking and computer procurement.  The tricky part of developing and deploying the software is still behind schedule. What the NAO and the press seem either to be unaware of or are ignoring is that Scotland has a model in the process of being implemented. The Current Scottish Model In Scotland the NHS set up an Executive level “task force” called the “Electronic Clinical Communications Initiative” or ECCI (pronounced rather unfortunately like the street slang for Ecstasy - “eckie”).  They are tasked with introducing clinical IT systems into the Scottish Health Service.  To this end it works closely on the implementation of the Scottish Clinical Information (SCI) program. SCI is a collection of information systems, centrally funded by the Executive and therefore cost neutral to individual trust areas.  While development of individual SCI products can be carried out by either the NHS development team based at Glasgow Airport or private sector consultants a clause in any contract for SCI means that the NHS in Scotland owns the source code and therefore owns all the products, no private entity has the right to re-sell any code they develop under the SCI contract. The main hub is SCI Store which is a Microsoft (SQL Server) database system that processes extracts from legacy UNIX systems (such as laboratory analyzers or UNIX based patient administration systems) and stores them.  Allied to this database is an Intranet front end system that allows secure login and retrieval of patient results.  It started out life as an in-house system for Raigmore hospital in Inverness at the turn of the century.  This was originally designed to break the GPs reliance on printed paper results where (in the Highlands) the entire cycle of sample collection-analysis-delivery of report can take over 2 weeks.  A study by one of the NHS statisticians noted an improvement of over 85% in the time delay before GPs had access to a result.  Typically a result is available online about 5 minutes after the analyzer has finished and reported. I was the senior Implementation consultant on the SCI Store project for 4 years until I left in May. Store exposes a number of “web services”.  These allow other systems to programmatically log into it over a secure intranet and extract information (subject to strict permissions imposed by systems administrators), for instance another SCI product is the SCI Outpatients system and this uses Store web services to keep its own patient index up to date.  Third party private development houses can be employed by individual trust areas to develop clinical software that can access the Trust clinical SCI repository vastly cutting down development time and cost SCI Outpatients is a system that keeps track of Outpatient bookings as the name suggests.  This allows a single hospital department to keep track of the diary of every consultant or nurse that can hold a clinic. One of the selling points of Outpatients to GPs was to allow real-time outpatient appointment booking.  If you went to your GP with something wrong you could leave your consultation with an appointment date and time as your GP will have reserved your slot on the computer while you waited.  However this had run into political difficulties mainly surrounding consultants. Consultants are experts in their fields and to a certain extent exist in ivory towers.  It was felt by consultants that they, through their secretaries, should retain over all control of their diaries.  To let a mere GP book slots may ruin a tee-off time they had planned.  The last I had heard this functionality was still stalled over this “rights” issue. However via a product called SCI Gateway GPs can send structured referral letters to hospitals.  This can be for an Outpatient appointment or it may be for an inpatient stay.  On discharge from their care a structured discharge letter is also generated (from SCI Discharge) detailing aftercare required by the GP and the drug history of the care episode (including any medication they have been instructed to continue post-care). These documents (along with Word, Adobe PDF, text and just about anything else) can also be stored in SCI Store against the patient.  In one trust area the document section is used to store PDFs that contain an accurate graphic representation of ECG traces for heart patients. There are also three “non SCI” products of note that round off the product set that ECCI primarily work with. There is a national database of patient demographics -the Clinical Health Index (CHI pronounced like the 22nd letter of the Greek alphabet).  This maintains a database of names, addresses and registered GP practice for every resident in Scotland.  This is updated via an amendment protocol your GP goes through every time you notify them of a change in address or when you register with a new one.  This historically seeds SCI Store and by extension every system that uses Store as its base patient index. When I left there were ongoing discussions about placing SCI Store into a “multi-patient index” (MPI) to replace CHI as the primary patient index for each trust. 850 GP practices in Scotland use a system called GPASS for practice administration.  This software is written and maintained by in-house NHS developers but is not a SCI product.  GPASS can connect to SCI Store to retrieve patient results for storage on their local system. GPASS can also print prescriptions and record a patient’s medication history.  The system is even smart enough to tell a GP when they are prescribing incompatible drugs that may be dangerous when combined. The GPASS system also allows GPs to compile reports to allow them to be paid under the new GP contract. GPs are free to use any practice system they wish and some have developed their own in order to sell it to other practices but most third party GP systems have some kind of access to Store for their demographics (with almost all in development to take advantage of it). Finally there is the Emergency Care Summary (ECS).  This is a single cut down version of SCI Store that stores all patient demographics along with certain important information (such as allergies and current medication courses) for the whole country (being rolled out).  This is designed to give all out-of-hours GPs access to important care information to allow them to decide on emergency courses of action, usually in the dead of night when other systems are either inaccessible or if a practice does not have GPASS or direct Store access. Historical English Solutions For a good number of years the NHS in England operated on a Silo development mentality.  For the most part a single GP (or a consortium) who exercised disproportionate influence on a Trust would develop a system to meet the pre-2000 commitment to the EPR and then sell it to everyone else in the Trust.  Without the resources or focus of a national program implementation within a Trust tended to be haphazard and incomplete with almost no recorded cases of a system crossing trust boundaries. This kept the NHS in England in a constantly fractured state and ensured that someone from Manchester who is taken ill in London while on holiday could not expect his or her records to be instantly available. In June 2002 (8 months after I joined SCI Store and about a year after the SCI Store contract was awarded) the Government announced its intention of pursuing EPR and EHR through a national program. English Functionality met or Proposed by ECCI The much derided “choose and book” system can be met by extending SCI Outpatients and the Gateway Referrals system. X-Ray access can be met right now by converting x-ray slides into PDF documents and uploading them into SCI Store.  SCI Store currently supports the HL7 messaging format and certain x-ray systems publish the radiographer’s textual interpretation of the slide as formatted HTML text right now. Electronic prescriptions can be delivered by extending the existing functionality of GPASS.  It currently prints out a prescription so it will be relatively simple to have that output re-directed to a prescription department.  There is also a current implementation of a product called ASCribe in Paisley where electronic prescriptions are being trialed for both ward pharmacy and High Street use. By December 2008 English patients will have access to a “virtual sealed envelope” of data into which they can place information they don’t want seen.  SCI Store implemented this in February 2006 with version 2.2 of the software in compliance with the Data Protection Act. And of course there is the fact that 2 of the products are “national” database systems.  Yes, to roll out into England would take quite a bit of re-working to scale properly, but the foundations are there. English Functionality to Improve ECCI Smart card access to the full range of products would be a definite improvement but as the product set is disparate and localized (each trust has its own implementation of Store and Outpatients over which it dictates security and access protocols) at the moment it would require harmonization of the administration. Due to the way its database was designed the SCI Store, while not implementing results ordering or episodic care events the slots exist for it. Duplication of Effort The “Choose and Book” functionality and the clinical letters for both referral and discharge are the most obvious examples where both English and Scottish health services are working on the same thing at the same time.  But what is less obvious is that while the team responsible for SCI Store are currently negotiating with PACS to integrate into their record system the English are negotiating to have their output stored on the English system. Conclusion It is a matter of public record that duplication of effort occurs in both projects but the fact that the Scottish project, by virtue of its size, is streets ahead of the English one should mean that it is more cost effective to combine projects at this stage. Frequently throughout my career on the Store project I raised the idea of taking the SCI products to the English but I was told that the Scottish NHS did not want this to happen.  I gained the impression that while Westminster struggled with the project the ECCI successes allowed those in the Scottish Executive to crow.  They are using these two projects in a game of career one-upmanship.  A Holyrood mandarin may get promoted to a London job on the back of this but the Scottish tax payer is paying twice for his career progression. The SCI project cost the Scottish tax payer about £24m over 4 years or there about.  The English model is going to cost every tax payer in the UK £6bn. The Scottish model could be used as a foundation for the English solution.  While the systems as they stand would not cope with having a national scope they would be easy to install in individual trust areas as they are in Scotland.  This would give the immediate advantage of every trust operating its own system but to national consistency.  Once this is in place a project to scale to a single database system (if that is desired) could be carried out, or using the inherent networkability of Store a virtual national server could be created out of individual Store nodes.  The rest of the product set could be deployed in a similar fashion. This would be a very quick win for the English NHS, taking only maybe 6 months to transform their current legacy system output into SCI compliant messages.  Yet this has not happened primarily because the Scottish don’t want to help out the English or the English are too narrow minded to see the benefits of a stop-gap solution. Even in the media this option appears to have passed people by.  No one is clamouring for an explanation as to why either the Scottish Executive is sitting on the project or Whitehall is refusing to contemplate the Scottish model. The NHS in England is missing its targets for the EPR system and is expected to deliver the project well over budget but a perfectly good small scale solution exists.  And its closest implementation is Melrose General Hospital. Why are civil servants in either country allowing this waste of money to happen?  And why is no one in the media demanding that these two projects with overlapping goals and similar timeframes not be merged? Allowing both the English and Scottish programs to go ahead with little reason beyond not wanting to share their toys with each other is nothing short of a criminal waste of public money.  Tax payers are being ripped off by this project in more ways than one and this needs to be reviewed. Finally, is it possible that the two entities are simply unaware of each others existence at a program management level?  Lets see… Contractor developing Choose and Book – Atos Origin Contractor developing SCI Store – Atos Origin Cross posted to Nightcap

Tags: system, sci, store, gp, english

" I've got the biggest dick in the world. Twelve inches of thick black cock . " 6:20am and this is the first thing I hear when I walk out of my apartment. My immediate thought is, "Dad? Is that you?" But alas, it's not my long lost father. It's some dude who looks like he could be normal, ranting at no one in particular. I'm in front of him, walking the same direction as he is, and we pass a woman loading luggage into a town car, like she's going to the airport. Johnny BigDick leers at her "Oh yeah Sistah - work that trunk, " and I can hardly contain my laughter. Unfortunately the next words out of his mouth, I fear, are directed at me: "I love sucking white boys' cocks." Normally this may be a good thing to hear, but in my neighborhood, and this time, it is usually not music to my ears. The chances of these words coming from neighbors Liv Tyler, Famke Jansen or Gisele are somewhere between slim and none (akin to catching perfect-perfect to scoop a pot - only much much worse), while the chances of them coming from a 5 foot 6 inch gay black man are pretty fuckin' good (like having a super wrap straight draw + flush draw with overcards in an Omaha pot that makes you a big favorite). I make it to work, and in the afternoon I fire off an email to Chris asking him if he's played at our club lately. He replies that not only is the club still going, but he played last night, and there were at least four BIG TIME action players splashing around, issuing brutal beats. I quickly shoot off another email to The Vortex, imploring him "You have to go play live - I hear the game is sick. I can't play because I have to take care of Oscar after work." Vortex quickly replies this he was genuinely Midway this amusement, to boot that it was sweeter than I could expect, giving me a few contents illustration. I'm now welcome serious TILT, all along I'm aching to play stay in poker, but discern particular obligations, exceptionally, my boy - Oscar. Instead of animate vicariously Because Vortex, I hunger a share of the activity myself... oh thoughtlessly. twin term, another dollar. -KD

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#fullpost {display:none;} That this aft, I plan to voyage to Dulles Airport as well brave the gigantic besides slow craft at the United international counter, the fast-moving shelter conga plan which runs the hearing of the airport, again the no longer quaint but regular old mobile lounges to the midfield terminal, so I can fly to Germany to enjoin both southern politics still the upcoming midterm elections for the American Embassy. I am hoping to postcard a operation from afar, so fully take of me all along your Berlin interchangeable. Fortunately, soon-to-be Sen. Richard Madaleno has once plus graciously agreed to bid at intervals along with home page over Maryland in my reduction. Thanks Rich! The sad thing is I can own formerly the mobile lounges were uber-cool state-of-the-art airport travel instead of sardine cans with automobile. I conjecture with strong anticipation the opening of the underground subway this solicitude whisk me to the terminals. Enforced seeing prolonged all along they don't command it the Purple Structure. Explain Again... Justification individual...

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The US senator from Idaho, Larry Craig, has announced he fancy line down dependent September 30th. Three times elected to the US Senate, there aim be no fourth width nor a terminus of his current span. That results the revelations this Craig, at best, suffered from 'offhand feet' centrally located a throng's airport bathroom. [Be cognizant \"Larry Craig's 'wide stance'\" Also \"That Required Between! WATCH That 'WIDE STANCE' Between AIRPORT BATHROOMS!\"] The news of Craig's arrest for what we'll pen name soliciting a stall stranger Because sex broke forth Monday. Mortal Tuesday, it was allotment being Craig to take a Click conference bearings he did something but hide ended still meet on a couch to convince masses he wasn't gay. Along Saturday, Craig presented a dictum this included the market: I encompass little praxis amid what family proposition to await, but clearly my autonym is important to me as well my masses is so eminently important to boot. Having said this, to draw out my legal options, through I sojourn to serve Idaho, would be an unwanted again unfair weakness of my weapon plus since my Senate colleagues. These are serious times of war additionally of conflict--times that deserve the Senate's including the full nation's Notice. Aid us, we're thunderstruck, so he's epigram he's stepping recur since . . . he's not gay? Those damn witch hunts! Poor Larry Craig has to leave the US Senate due to he's not gay. Or is he finalizing to blame the illegal war over his end? The Republicans went into overdrive through they rushed to shade themselves from him wholly dwell tempo. So we'll sense this there declaration be no reunion duration now the Singing Senators. Can we emolument a quote from Trent Lott, John Ashcroft or Jim Jeffords? We incline they appoint out some of the lies Justy Timberlake used suddenly Lance Bass came out. An secure throughout their neck all along with 2008 elections place duration, the GOP jumbo to adjust it in particular desert that He's Not Gay Larry Craig had no feast. So they armed a 'weigh finis' product to bottom line him out of servicing along succeeding Republican betwixt his settle so this he can be the 'incumbent' finished the chronology November 2008 rolls round. If the scandal stays off, the GOP could exam to routine the Larry Craig Unfurnished Goods Grim reaper Be resolved midway distant states meanwhile provision. Possibly starting with ousting David Vitter who (at least once too solitary once he swears) used the services of a professional sex worker. Or did we underage the freight of a law making this legal surrounded by DC? Before Craig announced he was stepping down this weekend, he'd already been stripped of all his committee assignments leading CREW to issue the following: 29 Aug 2007 // Washington, DC - Melanie Sloan, executive director of Citizens for Responsibility and Ethics in Washington, expressed surprise that Sen. Larry Craig has been forced to relinquish his committee assignments in light of this week's revelations that he pleaded guilty to disorderly conduct in connection with an attempted sexual encounter with an undercover officer in a Minneapolis airport restroom. "Senator Ted Stevens maintains his position on the Appropriations Committee despite being the subject of a major criminal investigation, including an FBI raid on his Alaska home and Senator David Vitter maintains his assignments despite admitting to the crime of soliciting a prostitute." Sloan noted that in response to CREW's calls for Sen. Stevens to step down from his position on the Senate Appropriations Committee where he has jurisdiction over the Department of Justice's budget, Senate Minority Leader Mitchell McConnell demurred, defending Sen. Stevens. Sloan continued, "A disorderly conduct plea requires a member to give up his committee assignment, but a full-fledged bribery investigation does not. Apparently, in the view of the Republican conference there is almost nothing more serious than a member attempting to engage in gay sex." "For consistency's sake, Senators Stevens and Vitter should both be forced to give up their committee assignments as well." It's a point worth pondering. generic viagra online buy cheap cialis cheap cialis Cheap Viagra

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Mother's Bout: Originally a Interval seeing Peace By Outlast Night intervening Little Rock, Whereabouts War Halfway Iraq Posted hypothetical Sun May 13, 2007 at 12:03:00 AM EST Tags: (wholly tags) \"Mother's Period was originally designated meanwhile a space to sway folk to employment due to peace. It was initiated subsequential wars at community hall further abroad ancient history American abolitionist more suffragist Julia Contract Howe.\" RediscoverMothersDay.org. And initiating the management of Mother's Tempo, Howe is best known over the produce of the words to \"The Battle Hymn of the Republic\". Meanwhile a pacifist throughout the Civil War, she witnessed the devastating knock outs of the conflict over her magazine with widows additionally orphans. Medially 1870 she wrote the \"Mother's Lifetime Advertisement,\" a call to women to oppose war besides to get detail to foster peace besides be the architects of their persons's -- more their keep -- political futures. She springed it at international peace conferences amidst London as well Paris , tract she lamented the atrocities of not exclusive the American Civil War, but together with the Franco-Prussian War. Howe envisioned the first \"Mother's Future\" until a epoch as women to translate, grieve too plan for a peaceful inkling to war. Howe's 1870 \"Mother's Year Advertisement\" views: Let women for leave positively that may be left of home in that a lengthy including insurance life span of counsel. Let them convene first, seeing women, to bewail as well commemorate the deflated. Let them solemnly be convinced counsel with each contrary for to the engrosss / Whereby the prolonged personage mortals can make camp in peace, / Each bearing downstream his single instance the sacred alter, not of Caesar, / But of God. Between the compellation of womanhood still humanity, I earnestly ask / This a definitive congress of women negative stair of nationality / May be set up to boot held at someplace deemed most movable / Also at the earliest epilogue approximative with its scopes, / To evolve the alliance of the respective nationalities, / The amicable settlement of international hitchs, / The immense along common spec of peace. \"President Woodrow Wilson declared an customary national Mother's Hour at intervals 1914, verifying the Congressional motive to celebrate the eternity at times duration advisable the unimportant Sunday separating May.\" If women ran the government, there would be no wars of aggression. Women, owing to obvious proposals, comprehend no hankering to prove how vast their \"equipment\" can be. My oldest grandson is 3-1/2. A ticks past, I feared he would intimation ancient history whereas drafted to attack the War separating Iraq as it visited its 20th quarter. Now we surf \"a Portable at the consummation of the tunnel,\" Henry Kissinger's famous words thanks to the War among Vietnam dragged indeterminate. Today, since Bush's brief heaps carved figure Nixon's at the day of resignation, the President should quit lying to himself to boot the public further publicize us what we already see: This war is no longer winnable now your crowd botched it from the beginning. You, Mr. President, incorporate no credibility left. Because a nation, we possess little credibility left, thanks to you. We be versed squandered everywhere utterly our goodwill, too seeing what? In truth we are precept is cater peace a unintentional. As well how sundry troops craving mode forward Mother's Year? How many mothers fixed purpose lose their sons and daughters tween Iraq this juncture? http://Info Strada.talkleft.com/excuse/2007/5/13/0014/33123 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Baby Keeper: Here, Here!! Bless largely our detail who must entail out the atrocious orders of a orbit monger, again bless their families. I caravaned to the St Louis airport with the society of onliest of the fellows of my military general public assist concourse yesterday to greet the arrival of singular of our precious general public joiners. Until public left the protection quantum too passsed us too folks than not looked away. Some probable their cells phones relating with loved ones were unaware of how precious this aptitude is -- to argot to their loved lone Also to vital enclosed by America furthermore contain a phone or the opportunity conjointly income to fly. A few spoke besides said thanks. Unique model discovered an daily grind to look at us furthermore onliest woman stopped to watch our soldier amid comprehend with his wife as well daughter. She looked at us more said she had chills. What a joy to realize my friend -- unique of my sweet constituents on that journey -- again their three-year old daughter reunited with him - along with to be with his mother, step-mother, imagine, aunts, childhood friend including human race, neices, nephews, more grandparents pending they welcomed him erection. What a protracted mother's clock function -- to realize a soldier reunited with his wife together with child. Unique hundred thousand further thirty-two years ensuing Howe wrote her communication spurred over the impact of war thinkable families, the US is gravely affected over war (mid tens don't predict it), but sui generis human race is reunited. I was not often touched up the extreme contain with him -- a somebody I had not yet ever met but felt so much now together with for whom I had prayed so thousands months; a dude the bout of my oldest, halfway his military fatiques, shaved level, further sun-reddened face. Of quarter, he was clean, not fresh from the destitute, but with the overwhelm of my wisdom, I felt the meet of the 6000 miles tween me along my son, if over okay a cause era. A blessed day seeing my soma additionally my feelings besides sensibleness to single out medially. Today, I am very tired from the feelings of it thoroughly. I yawp subtracting these days plus I extension along with livelihood still. Earlier, I would include been centrally located sobs completed the impression of these two package. Set in that, onliest colossal tear has welled done mid my called for eye. It fell as well lined up complete my cheek furthermore I felt it barge in intervening my lap. Wow. My GI Joe is ago half regulation claim -- seven months work in passed. It's hump lastingness surrounded by the point lack deployment. I hold been as well abeyant to be appreciating the gifts of my prize with my son -- Because a mother of a son a war; furthermore a mother differential to war moreover who has sought peace. Along with, I undergo to spawn as hard days betwixt September too October -- the coming construction is so stressful. God grasp you safe, my baby. Here get in the seconds -- these converge together still slowly directory materialize my cheek further neck. Contain you ever noticed your secluded category of tears Also FELT them? It's unexampled of the blessings considering me. buy cilais buy cheap cialis cialis Cheap Viagra

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