Document

https://nww.stuff.nhs.uk

Or Whither NHS net

Why?

Long personal involvementCentral to all the changes that surround usKnowledge is powerPretending it isn’t going to affect us is not

an option

Why?

Not for coding clerks.– Who don’t have a long term future.

Not just for the IT department.

For us all, clinical workers and management workers alike.

What?

The NHS plan.Information for health.

• 1998

• Our LIS.

• Our local funding.

Building the information core.• Jan 2001.

Other bits from all over.

Strands in All This

Communications

Records

Information

Strands in All This

Maybe money?

New Ways of Working

Not bolting computers onto existing practices

About redesigning work

Redesigning care

New pathways in the jargon

NET Targets

Secondary careSecondary care

Clinical and support staff;

25% have desktop access by now– Really is 20% ‘ish

100% by 2002

Primary carePrimary care

GPs and managers95% practices

connected by now– Really is 80% ‘ish

90% desktop access by now– Really 50% ‘ish

All 100% by 2002

But but but but but !

Uses Now

EmailNet browsing Information sourceFax out (doesn’t

work!)NSTS (not that

reliable!)

Reading the stuff the NHSe no longer publishes – cures insomnia.

National address book?

GP registration links. GP IOS links – for the

brave.

Security

Lags behindCaldicott

– Awareness– Safe havens etc etc

National audit scheduled for Dec 2001 – To BS7799

NHS cryptography – Roll out spring 2002– Public key encryption

What Next? – Uses of NHS net

National priorities are pathology requests and reports.

Then xray reports and requests.Booking.Discharge information.

Jargon

EPREPRElectronic Patient

Record– ? Attainable

EHREHRElectronic health

record– ? Holy grail

Clinical Terminologies

Coding viz classifications

Read 3– Ends 2003

SNOMED – CT– Starts 2003

? Legacy coding and classifications

EPR Level 3

Integrated patient master index.• PAS.

• Departmental systems (all departments)

Electronic clinical orders and results reporting.

Prescribing software.Multi-professional care pathways.

EPR – Primary Care

RFA99 legalises electronic records.RFA99 roughly equates with levels 4-5 of

secondary care EPRs.Big problem is hospital letters.

– ? Scanning.– ? EDI.

? 90% of practices ? 90% of practices by 2003by 2003

EPR – Primary Care

Integrated nursing and medical EPRs are coming.

National framework expected in Sept 2001.

End of many Korner MDS expected in next month or two.

Local initiatives already underway.

EPR – Out of Hours

National programmeTo make summaries

of GP EPRs available 24 hours a day

First to GP out of hours services

Then to A+E departments

?? 2005

EPR – Mental Health

Separate plans for mental health EPR.

Separate funding stream. Integrated social and

health records. Shared with social

services. 25% by 2003 ? Locally ahead of the

game.

EPR – Acute Hospitals

Weird set of levels defined by the NHS

35% of acute trusts to have a level 3 EPR by 2002

100% by 2005 Plenty of words and

management speak out here – few systems!

Local Status

9 practices have full desktop NHS net connection.

All practices should be connected by end of year.

16 practices have new LANs.

6 practices “paperless.” 5 practices going

“paperless.”

Local Status

FHN has connection. FHN has too poor a LAN

for full desktop access. We have started a project

for pathology reporting and requesting.

We hope to add in radiology soon.

Networking information sources is proceeding.

Information

NICENeLHProtocolsPoliciesGuidelinesHiMPsCHiMPs

And uncle tom cobbly….

Payroll and HR

A national payroll and HR system is planned to start rolling out in 2004.

Doing away with individual organisational arrangements.

Caveats

Knowing that nurses share the same records and can rapidly communicate with doctors will allow more task sharing, profoundly changing the nature of medical work.

Caveats

A lush information landscape where information is shared with patients leaves some things unknown:

If 1% of patients join the worried well?

Sharing all records with patients?

Caveats

How much extra time to spend capturing and structuring records?[1] – 30 minutes plus per day.

– [1] Tierney et al JAMA 1993;269:379-83.

Caveats

Are we ready to share our information with patients ? – The strategy says there are irresistible

arguments for this.

Caveats

ControlGovernanceAccreditation (and Re- )Performance related payPolitics

Or just my depixol dose is late.

A Personal Hope

Clinical Needs

Not

Technology for its own sake