CSW
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RivComTechnology Supporting Migration
Case Notes has been designed with recognition that the most usual scenario in today’s healthcare practice is one where many different systems co-exist, within an infrastructure with many complex interrelationships both in systems and in working practices.
Generally, it is not feasible in one step to replace many existing systems, across multiple organisations, with a single system that implements shared care across all. Indeed many of the systems already deployed can, and should, be retained in a future scenario of joined-up, pan-community care based on a single record.
Case Notes not only provides a complete solution to shared care, it also provides technology that supports the staged migration from today’s deployed scenarios, to a combined care records system, based around the patient and accessed by all care professions working in every care organisation.
The approach in Case Notes is first to integrate and manage information from disparate systems as a singe record view, and then to extend and consolidate clinical functionality, based around that record. The progress of migration can be planned over years, to dovetail with organisational and process change.
In the first stage of migration, clinical information from existing systems is integrated and re-organised into a single, patient-centred view.
The Import module in Case Notes allocates incoming XML messages representing ‘events’ in the patient record to the correct patient. The messages are derived from the source systems through ‘interface adaptors’ which can push information to Case Notes, or pull information from the source systems. The Import module can also operate through an intermediate messaging hub, which provides additional transformation, routing and error handling capability.
In Case Notes, the patient centred record is viewed using a web browser, through the Access Control Framework, ensuring that each item in the record is viewed by authorised users, with the appropriate access permissions.
Although Case Notes can run as a virtual records system, integrating information from source systems in real time, it is most powerful when run with its case-based repository caching the data from the integrated systems.
The single case-based record repository provides the resilience, performance and integrity required in a records management system. It ensures that the full record is always available, regardless of the availability of the source systems. Performance in retrieving the record is based on Case Notes, not limited by performance of any of the source systems.
With an integrated, patient-centred record in place, the entire record can be backed up to provide resilience, continuity and integrity in the audit trails created by Case Notes.
The next stage in migration is to plug in new modules, providing clinical functionality for all caring professions, both reading from and writing to the single care record for the patient.
Unlike the source systems, which are loosely integrated through XML messaging, the modules are tightly coupled, using the Case Notes module and programming interfaces to create a two-way interaction with the record.
The cross-agency shared care functionality – Assessment, Referral, Discharge, Ordering, Results Reporting Prescribing, Care Planning, etc – is tailored to the user through the Access Control Framework, whenever and wherever accessed.
The final stage of progression to integrated Shared Care comes when existing source systems are consolidated by replacing multiple loosely coupled systems with a single, more tightly integrated module performing equivalent functions.
The consolidation can be made over a period of time, in a controlled manner, with a number of alternative options.
Where a number of different source systems with the same scope of functionality have been integrated, one can be selected and integrated more tightly as a Case Notes module (selecting ‘best of breed’).
With the core Case Notes installed, additional modules can be added over time, to build up a complete Electronic Shared Care Record System. Modules supplied by CSW, or provided by third parties, are easily plugged into the core system, using a simple XML configuration which provides instant integration with the user interface and Access Control Framework of Case Notes.
