Minutes of a Meeting of the Clinical Governance Committee held

							NHS Greater Glasgow & Clyde




                       Meeting of Information & IM/T Sub Group
                               Notes of Meeting held on
                                    22nd August 2008
                               Executive Meeting Room
                                      North CHCP

PRESENT Mr Enzo Benoni         Primary Care IT Department
        Ms Janet Boyd          Primary Care IT Department
        Mr Tom Clackson        GMS Contract Manager
        Mr John Clyde          Keep Well Project Officer
        Mr Kevin Hutchison     Keep Well Social Referral Co-ordinator – North
        Mr Marc Lang           Primary Care IT Department
        Dr Susan Langridge     GP Representative
        Ms Sandra Moore        Keep Well Social Referral Co-ordinator – Inverclyde
        Dr Caroline Morrison   Consultant in Public Health
        Ms Lauren McCormick    Keep Well Social Referral Co-ordinator – West Dun
        Mrs Irene MacPhail     Keep Well Social Referral Co-ordinator – East
        Ms Louise McTaggart    Primary Care Information Services Support Manager
        Ms Yvonne Neilson      Health Improvement Officer
        Ms Marion O’Neil       Keep Well Social Referral Co-ordinator – SW
        Dr Anne Scoular (Chair)Consultant in Public Health
        Ms Marian Stewart      Director, Information Technology
        Mr David Duff          Primary Care IT Department
        Mr Mark Darroch        Primary Care IT Department
        Mr Michael Martin      Practice Manager - SW
                                                                       ACTION
1.   WELCOME, INTRODUCTION & APOLOGIES

     Apologies were received on behalf Malcolm Bennie, Jackie Britton and
     Lorraine Newton.

     AS opened the meeting and introductions followed.

2.   NOTE OF PREVIOUS MEETING

     The note of the meeting held on 24th June 2008 was agreed as an
     accurate record.

3.   ACTIONS ARISING FROM PREVIOUS MEETING
     (i) Admin Support to Group

     AS had spoken with Linda de Caestecker regarding admin support for
     this group. Linda had advised (on behalf of the Keep Well Project Board)
     that the current arrangements should continue. The group agreed that
     Dalian House was a suitable central location for all members and this
     was the preferred location for future meetings, subject to space being
     available.

     (ii) Business Rules

     CM updated the group on this issue. She advised that no further
     changes had been made to the business rules, because a major re-write
     is required for the March 2009 issue. It had therefore been decided to
     use the existing business rules for the time being. These will be
     reviewed at a later date, with a view to making significant changes. TC
     agreed to issue a letter to all Wave 2 practices to ask them to ignore
     colour coding this would now be sent in the light of this new information.       TC

     (iii) VPN

     MO reported that there were still many services in Wave II with no VPN
     facilities and added that the process for securing VPN seemed
     unnecessarily tortuous. MO had passed the relevant details to Janet
     Boyd, then subsequently received notification that this also needed to be
     signed off by line manager. It was suggested that a clear protocol
     outlining the process for getting a VPN set up would be extremely
     helpful.

     The following contacts/services currently lacked VPN access:

     SW: Outreach Worker, Health Case Manager and Health Counsellor.
     W Dun and Inverclyde: all external services

     MS suggested that one person should be the single, named point of
     contact for taking this forward, rather than multiple contacts. MS agreed
     to speak with HI&T and ensure that a named person is given                       MS
     responsibility for this.


4.   UPDATE  ON   CURRENT                ISSUES       FROM       KEEP       WELL
     COORDINATORS

     South West

     MO reiterated the ongoing issues with VPN and was concerned that this
     would give a false picture of referral outcomes. She also informed the
     group of two practices who have approached the South West team and
     enquired about taking part in the project. However, one is an EMISS
     practice; this request had been taken to the Project Board, who asked
     that the issue was referred to this group. The problem is one of capacity
     to develop the necessary screens; DD agreed to explore this further.             DD

     MO is currently keen to evaluate the role of the case manager and
     outreach workers and would need the appropriate reports. She was also
     keen to have the facility for case managers to have access to data on
     multiple referrals, to allow them to support the patient in prioritising these
     (at present, services cannot see whether the patient has been referred
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to several agencies). MO proposed an option to refer to the Health Case
Manager when referrals are being made, thus creating a middle tier in
the referral process, with the Health Case Manager activating the
referral when appropriate. A discussion took place regarding expanding
the list of criteria for referrals for more accuracy/clarity around data
capture. CM asked if there was a need to have some text on the
tracking tool to support this, adding that North and East would need to
be involved in the process. ML suggested meeting up to discuss this.
AS said she would like to also attend this meeting once arranged.                AS/Reportin
                                                                                 g Subgroup
MO then went on to talk about change requests. MO asked if “Fax”
could be added as an optional mode of referral to smoking cessation
services. KH expressed concerns about patient confidentiality and data
protection, advising that Wave I sites don’t use fax for this reason. It was
agreed that the option could be added, allowing practices to use this if
appropriate safeguards with faxing patient details were taken, in line with
existing Health Board policy.                                                    MO

MO felt that it would be helpful to have a more refined tracking tool that
would better separate out the various engagement methods (eg
‘outreach’ is currently always classified as a home visit). CM suggested
adding new drop down options to record different methods. ML agreed
to have a look at this.                                                          ML

KH suggested a meeting takes place between Wave I and Wave II to
discuss/agree change controls.

MO also asked about use of the ASSIGN risk scoring system. One SW
practice doesn’t use ASSIGN, so asked whether they have to now go
back and redo the scoring at this point. CM confirmed they don’t, as
they will be using an alternative risk scoring system its absence. LMcT
will investigate the situation with the practice and try to resolve this issue   LMcT
for the future.

North

KH advised that there had been major data extraction issues with JBS2
and now cholesterol, which had emerged when data were required for
Glasgow University’s economic evaluation. Practices are currently
inputting data, but the systems cannot extract this information, so              ??-   check
practices were irritated over this current issue. Arrangements had been          who
made to give practices a briefing paper to guide them on re-entering this        actioned
information.                                                                     this

A full discussion followed on the circumstances surrounding this
problem. ML informed the group that there were several underlying
reasons, concerning both data entry and extraction. In addition, an email
server used for data extraction had been removed without any
notification to the IT Dept. ML had met with Kenny Lawson about the
required dataset, when the figures provided after the initial meeting
seemed very low. A full GENIE reset had subsequently been done, to
re-extract all data contained within practices’ IT systems. This had
revealed various issues about both quality and quantity of data. CM/ML
noted that if data goes in, it can be pulled out. ML has been working with
a practice in East Glasgow, who agree that the data are now complete
and accurate, as entered.

LMcT noted that the training team had never been told to record HDL on
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the labs template. ML confirmed HDL is on Keep Well CDM template.

AS asked if there were unmet training needs. All coordinators agreed
that there were and hoped the mentoring team could help. LMcT
indicated that practices already knew to contact the mentoring team with
any training requirements. It was felt that there had in some instances
been too long a gap between the training and implementation of the
software. Several solutions were proposed:

LMcT to email all Keep Well practices and emphasise availability of         LMcT
support

MO has a form/template which she gives to Practices to raise training       MO
issues. She offered to share this.

CM noted that Practices must know clearly who to contact and how to         All
contact them.                                                               coordinators

Co-ordinators should liaise closely with LMcT in ensuring training needs    All
of practices are identified and met.                                        coordinators

KH noted that ASSIGN training will be carried out on 9th September
2008.

KH also advised that in the past two services had been using data
sticks/pens for data storage, but new guidance in the form of a policy
has stated this cannot continue. KH is trying to resolve this and would
advise the group on the solution.                                           KH

West Dunbartonshire

LMcC advised that most of the local IT issues in West Dunbartonshire
had already been covered today. Additional points included: VPN tokens
ordered, but still not arrived. Screens for EMISS and VISION practices
were expected next week. 14 practices still do not have the tracking tool
populated. Finally, change control issues around employment/benefits
services.

Inverclyde

SM reported confusion around payment screens, which will be resolved
by TC’s letter (see 3(ii)). ML confirmed that the payment screens would
be ready one week from today. She also reported that BP recordings
are not being pre-populated. ML advised that he was prioritising
resolution of this problem (related to extraction issues in Clyde) as a
matter of urgency.                                                          ML

CM suggested that development of EMISS compatibility would require a
huge amount of work. MO would like this developed, as the practice is
very keen to be involved in the project.      It was suggested that the
practice is invited to develop the templates, with the support of the IT
development team for cross checking against GPSS. It was also noted
that data extraction could be problematic, but that this was an issue
beyond local control and should be referred to the national ISG.            AS/CM

East

IMacP reported that there were ongoing problems with creating reports,
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     with data missing. The actions taken had been discussed in relation to
     the North site.

5.   REPORTING PROPOSALS

     ML briefed group on his paper. CM noted it meant different things for
     each of the sites. AS asked all coordinators to summarise the key reports
     which they believed were needed and useful. KH was keen to see an
     invite method breakdown, CM wanted to see greater use of clinical data
     in the reports, MO asked for more reports at practice level. ML noted that
     all these data are available and simply need to be manipulated to answer
     all of these questions.

     AS suggested a small working group to progress these issues, with
     clinical representation, all coordinators and IT input. The group was keen
     to see a template for collecting national clinical indicators, appropriate
     text and interpretation on national reports, which should be presented in
     a consistent format for the forthcoming national monitoring report in        AS
     October.

6.   CHANGE CONTROL ARRANGEMENTS

     (i) Updated health improvement process map

     YN reported that no comments had been received on the previously
     circulated draft. Heather has now presented this to most of the relevant
     CH(C)P Health Improvement Managers and will be taking this forward
     now.

     (ii) Sharepoint experience

     SM asked if sharepoint training was available. As an alternative, CM
     suggested adjusting the existing paper/instructions on how to log on to
     sharepoint.

7.   EVALUATION PROPOSALS

     AS, working on a paper and will forward on by the next meeting. Key
     message is IT systems need to develop around what we want to learn
     from Keep well.

8.   STAFFING CAPACITY

     DD, interviews on 1st September 2008. DD explained his role as
     Development Team Leader which he began 3 weeks ago. ML is still
     helping out, for the time being. DD will now be the contact for the LES
     template. TC noted that 2 analyst posts went to Frances Paton,
     advertised hopefully today (22.8.08). KH noted that the additional posts,
     following email from ML, are;

           Systems Developer (ML replacement)
           Mainstream GMS LES Post (Tom Clackson’s team)
           2 x Data Analyst Posts (based with Frances Paton’s team)

9.   YEAR TWO CONTENT

     CM advised that the purpose of this was twofold; clinical follow up and

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      evaluation. If there were gaps in the data from 1st consultation, practices
      should try to input these data, to complete the first consultation.
      Breast/Cervical screening, ask Nurse to encourage uptake. CM had
      emailed DD on technical detail.                                               DD

      CM was keen that data quality was improved, with consideration of
      incentivising practices to do this. AS noted that a proposal would be
      required, CM is happy to put one together, but that SL/TC set out some        SL/TC
      principles and guidance on the options, for the group to consider further
      at the next meeting. AS would then take this to the Project Board. CM
      asked if ML to find a suitable code for the 2nd review.                       ML

10.   AOCB

      Group noted issues around employability. KH/IMacP/MO will meet to             KH/IMcP/MO
      agree.

      The possibility of a free text box to capture reason for non-attendance
      and what would make a person attend was considered potentially
      helpful. CM asked the group to give the text some thought and also            IMacP/JC
      suggested taking issue to the evaluation group.

      Letter from green gym - the referral path is one where patient must be
      referred to health counsellor. AS to reply.                                   AS

      CM noted that nationally information is being collected differently and
      there are different types of data. Three options were made available, the
      one which was selected was “Amend indicators to reflect date is being
      collected”. CM will pass papers to John Clyde to distribute to group.         CM

      Meeting closed.

11.   Date of Next Meeting

      The next meeting will take place on Friday 12th September 2008, 11.30-
      2:30 pm, Board Room, Centre Block, Glasgow Royal Infirmary. Lunch
      will be provided.




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