1. What is a Key Information Summary (KIS)?
The KIS (Key Information Summary) is a new IT development in NHS Scotland pioneering a shared medical record between healthcare professionals. It allows selected parts of the GP electronic patient record to be shared electronically with other parts of the NHS, using a template within the GP clinical system, and is more efficient and safe than previous paper-based and email-based methods. The level of detail contained on a KIS will depend on the complexity of the patient’s clinical condition, and it is designed to be added to over time as the patient’s clinical condition progresses.
2. What information is contained in a KIS?
KIS is an extension of the Emergency Care Summary (ECS) database and so in addition to the information available on ECS (ie patient demographics, medications and allergies) the following information may be included, as appropriate to clinical need:
- Past Medical History (High-priority read codes are automatically included)
- Baseline functional and clinical status, including capacity
- Triggers for deterioration
- Current care needs and arrangements
- Emergency Contacts and Next of Kin Details
- How far to escalate care
- Preferred place of care, and final care, other specific patient/carer wishes
- Palliative care information
- Legal issues such as power of attorney
- DNACPR status
- Special alerts – for example around staff safety
Often the most useful information is contained in the freetext section of the KIS (the “special note”) as this is designed to provide a précis of the most relevant clinical and social information for a particular patient. The question that guides GPs when completing this part of the KIS is “what would I want to specifically know about this patient if I was the clinician seeing them out of hours?”
3. Which patients are chosen to have a KIS?
At present between 2 -3% of Scottish patients have a KIS, selected by their GPs as those with the most complex health and/or social care needs. These numbers are likely to increase with time, and generally include:
- Patients with long term conditions, in particular if they take multiple medications and attend multiple specialist clinics
- Patients who are likely to present to unscheduled care at the weekend or out of hours
- Patients who may find it difficult to communicate in an emergency (for example, people who have communication or memory problems, mental health issues or learning disabilities)
- Patients with palliative care needs
4. How is a patient KIS created?
A KIS can only be written from within a GP practice because it is “housed” within the GP clinical systems (either Vision or EMIS) and pulls its information from there. Much of the information on the KIS form is automatically pre-populated, with other information being added as clinically appropriate in the form of drop-down menus, or freetext for the most individualised data. NHS Lothian have designed resources and pathways to allow clinicians based out with primary care to be able to contribute to the information contained within a KIS (see Q7 below). These resources are available for sharing with other health boards.
A KIS automatically and electronically updates from the GP practice clinical system every few hours so any new information added (such as new medications, allergies, demographics, change in GP surgery, new coded medical problems etc) will always be visible to unscheduled care users as the most recent version of the KIS.
6. Who all can access KIS?
Because KIS is an extension of ECS, all users who have access to ECS also have access to view KIS, through various different IT interfaces:
- All Secondary care users
- Out Of Hours service and NHS24
- Scottish Ambulance Service
- Hospital Pharmacies
- Mental Health Units
7. How can I update KIS or write a KIS if I am not able to access the GP Practice System?
NHS Lothian have developed a form that allows district nurses or other community staff to update or create a KIS without having access to the GP Practice system. This resource is available for sharing with other health boards or can be accessed via their local intranet at http://intranet.lothian.scot.nhs.uk/NHSLothian/Healthcare/A-Z/AnticipatoryCarePlan/Pages/default.aspx . The brief version is designed for hospital use.
This is designed to be emailed (rather than posted – to allow cut and paste) to the GP practice clinical mailbox.
8. What are consent arrangements for viewing a KIS?
A KIS can only be created with explicit patient consent, and should ideally be written in conjunction with the patient and/or carer. In very exceptional circumstances, in line with Data Protection Act guidance, patients may have a KIS created and shared without explicit consent. This would include circumstances where the patient lacks capacity (such as severe dementia, learning disability, young age) or when the patient is considered to pose a significant risk to themselves or others. As the consent issues are addressed by the clinician at the time of writing a KIS, further consent does NOT need to be obtained at the time of accessing in secondary care, and this includes information stored in ECS. A patient information leaflet explaining what KIS is can be found here http://www.ecs.scot.nhs.uk/wp-content/uploads/2012-10-09-KIS-Patient-Leaflet-v1.0.pdf
This is different from consent arrangements for viewing solely ECS data. In the situation where the patient does not have a KIS and only has ECS data available, explicit consent does need to be obtained to view this information.
This is because KIS in an opt-in system and ECS is an opt-out system, reflecting the different levels of clinical data that are shared through either system.
9. Where can I get further information about KIS?
Further information can be viewed at: http://www.ecs.scot.nhs.uk/kis
Dr Carey Lunan, Primary Care Clinical Lead in Anticipatory Care Planning for Edinburgh CHP