Durham and Darlington ICRS Where to start?
Jan 12, 2016
Durham and DarlingtonICRS
Where to start?
Dr Grant Kelly
BMA Council
Chair, BMA ITC
Chair DoH EPB – now:
Privacy Enhancing Technologies Project
SEAG of GPRD
Chichester GP 21 years
Background 1
NWN 1994
“All patient data is to be accessible to the wider NHS family, and all those in contract with the NHS”
Background 2
“You have zero privacy anyway; Get over it.”
“Privacy is transient; it began following the demise of an all-seeing God and stopped when government, sensing a vacuum, stepped in to fill the gap”
Background 3
“Internet technology has evolved to support interaction between organisations with neither common aims nor management; as such it is ideally suited to the NHS”
Jonathon Kay
BMA/clinician view
We need to move forward
We appreciate the potential of electronics
Fully-functional, progressing e-NHS
We (variably) recognise the mountain (range) we have to climb
What’s the aim?
To replace paper by electronics for:SpeedEase of useAvailabilityReliabilityAdded valueAnd with a net gain
….tough
Paper
Needs no power
Available (?)
Universally understood/useable
Law, business of supply, etc
Standards in place
Public acceptance/handling
…but
But:
Illegible
Gets lost/de-structured
Available in one place only
Is passive
Not a learning/auditing medium
………..time to move on
Non-negotiables….
Availability
Ease of use
Minimise consultation damage/Heisenberg
Confidentiality
Integrity
Authenticity
Non-repudiation
ICT thoughts
An unlinked computer is a waste of space
Linking computers (can) save work
Linking computers (can) reduce errors
But
only by establishing identity/access control
and using EDI
What’s out there?
?
What we’d like……
DVLA
HA SS
Partners
GPs
Data Store
PH
Trusts
MH
EPR
MH Partners
GPsPH
TrustsSS
HA
Clinical teams and information
Patient-present needs
Patient-absent needs
Definitions for clinicians
Integrated…
Joined together
Federated
Conforming despite time & space
Appears to work as one to the user
‘Direct’ Care
The processes employed to improve a person’s lot when suffering from disease and its adnexae
Complex
Easily understood
Not so easily measured
‘Remote’ care
Planning
Information organisation
Booking
Referrals
Dispensing
Pathology etc.
Records 1
The abstracted knowledge about a person that enables efficient, accurate and appropriate care to be given to them
Records 2
DemographicsHistoryWishesDisasters/SuccessesWarnings ConsentConsent to publishetc
Service
Providing this to quality standards
Providing this to technical standards
The provision of derived added value
Hurdles
Who agrees the scope?
Scope creep
The different views
Procurement & testing (solutions)
Legacy staff & kit
Maintaining local apps
Integrity/Authenticity/Privacy/Consent
More than just a record