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Diabetic Retinopathy Screening Services in Scotland: Recommendations for Implementation



Diabetic Retinopathy Screening: Annex G

SCI-DC - Scottish Care Information Diabetes Collaboration

The SCI-DC (Scottish Care Information - Diabetes Collaboration) Project aims to deliver effective information technology solutions to diabetes services in NHSScotland. The Scottish Diabetes Framework identified that well-managed, integrated diabetes care must be underpinned by effective information technology systems, and the SCI-DC Project was initiated to drive forward the IM&T milestones identified. The project aims to support the Scottish Diabetes Framework and the building of regional Managed Clinical Networks by the provision of supporting IT software and services. The project is funded for three years from April 2002.

SCI-DC is directed by a clinically-led Steering Group with strong representation from both primary and secondary care. The SCI-DC Steering Group is chaired by paediatrician Dr Kenneth Robertson. This group reports to the Scottish Diabetes Group - the national steering group responsible for the implementation of the Scottish Diabetes Framework and for ensuring the co-ordination of national diabetes developments. It also reports to the IM&T Programme Board, the national planning and co-ordinating body for IM&T developments in NHSScotland, via the SCI Programme Board.

Project Management is provided by the Information Systems Support Group of the Information and Statistics Division of the Common Services Agency. The Project Team operates from the Clinical Technology Centre at Ninewells Hospital in NHS Tayside.

The SCI-DC project will be delivered in two phases. The first phase builds on the success of the Lanarkshire Diabetes System (LDS) and the Diabetes Audit and Research in Tayside Scotland (DARTS) systems and aims to maximise the benefits associated with these systems by making them freely available across NHSScotland. Some development work has been required to produce generic, robust and supportable production versions of these systems for national roll-out, and the resulting products are known as SCI-DC Clinical and SCI-DC Network, respectively. Central funding is available to assist with the procurement of hardware in support of the roll-out programme.

The SCI-DC products are complimentary, each with a different focus. SCI-DC Clinical is designed to provide hospital clinic-based support, delivering such features as the automatic generation of GP letters. An interface has been developed to take the clinical data captured by SCI-DC Clinical for automatic update of the patient record held on SCI-DC Network.

SCI-DC Network allows for the identification of all people with recorded diagnoses of diabetes in the area, and provides full support for the Scottish Diabetes Survey. Its regionally customisable web pages allow access to standardised treatment guidelines for decision support, and provide access to patient leaflets and local information such as clinic times and eye van schedules. SCI-DC Network allows for automated practice audit in support of clinical governance, and contains such features as graphical representation of laboratory results over time, allowing for longitudinal risk to be gauged and providing a focus for discussion with patients.

The first phase of the project has three main objectives. The first is to introduce widespread use of IT systems to diabetes services across Scotland in a short time frame. The second is to deliver the benefits and maximise the potential of systems which have been tried and tested in a clinical environment over a significant time period. The third is to pave the way for the introduction of enhanced clinical functionality to be offered by phase 2 of the project.

The second phase of the project develops and extends clinical functionality to provide more closely integrated and fully-functional IT solutions for the use of those involved in diabetes care. This phase builds on the functionality provided by SCI-DC Clinical and SCI-DC Network and extends it to ensure that it remains relevant, effective, forward-looking and sufficiently flexible to support different ways of working. The need for ease of access to integrated solutions, extended support for multi-specialty clinical care, and the facilitation of call/recall for diabetic retinopathy screening are all recognised as critical components of this second phase. The principal concept underpinning the SCI-DC initiative is the creation of a single shared electronic record for use by all involved in the care of patients with diabetes mellitus.

The roll-out phase of the project started in the summer of 2002. Implementation programmes are currently underway in four Health Board areas (October 2002), and implementation planning is in progress with those areas wishing to start implementation of the SCI-DC products in the coming year.

SCI-DC Steering Group also took responsibility for reviewing and updating the diabetes dataset. This has now been published as the Scottish Diabetes Core Dataset. SCI-DC products will continue to evolve and will be fully compliant with the national dataset. Although the use of the software produce by SCI-DC is not mandatory for health services in Scotland, it is expected that all data collection systems will, over time, be compatible with the core dataset.

More information about SCI-DC can be found on the website at www.DiabetesInScotland.org. Contact with the project should be made through Julie Falconer, SCI-DC Project Manager, email julie.falconer@isd.csa.scot.nhs.uk or telephone 0131-551 8431.