NHS England: 2014 and the need for networks Professor Jonathan Kay, Clinical Informatics Advisor, NHS England

Dr Jonathan KayClinical Informatics Advisor

NHS England

The need for networksMarch 2014

Prof Jonathan KayClinical Informatics DirectorNHS England

Computerisation

• Can improve patient safety• Reduce discontinuities

• Within organisations• Between organisations• But… Passive approach to safety management

• Can reduce unit cost of processes• Remove tasks from humans• Reduce waste• But… Ignorance of unit costs of processes

The NHS in England

• 7,600 GP practices (partnerships, self-employed)• 161 acute trusts • 56 mental health trusts• 36 community providers (including 18 social enterprises)• 10 ambulance trusts

• Net expenditure has increased from £57 billion in 2002/03 to £105 bn ($159 billion) in 2012/13.

• Expenditure per capita per annum has increased from £1,287 in 2003/04 to £1,979 ($3,008) in 2010/11.

NHS England

• Commissioning body for healthcare• Created on 1 April 2013

• Receives funds from the Department of Health• Receives an annual mandate with priority areas

Commissioning care

• Primary care commissioned by NHS England through the national GP contract

• Secondary care commissioned through 211 clinical commissioning groups, run by GPs, funded by NHS England

• Specialised care commissioned by NHS England

• Social care funded and delivered separately

Clinical information systems: GPs

• Fully computerised, many for over 20y• Dedicated vertical market suppliers• Computerised delivery of laboratory reports• Computerised patient registration to national system

• Large amounts of time spent importing and exporting information

• Used by GPs but not all primary care staff

CIS: Hospital care

• Fully computerised functions:• Patient registration• Laboratories (and most requests and reports)• Radiology (100% local PACS)

• Departmental systems…

• Architecture• “Best of breed” vs “Single EPR”• Communication to national system

Weaknesses of current CIS

• Often based on single organisations rather than needs of clinicians or patients

• Inflexible

• Problems with interoperability

• Problems with standards

• Poor or nonexistent evaluation

• Little or no knowledge management

National systems

• Demographics• Private network and email system• Summary Care Record• Choose and Book

• Aggregated activity systems

Clinical Digital Maturity Index

• Collaboration with eHealth Insider• Now launched, free access for the NHS• How should it develop?

What do clinicians tell me?

• Feels backwards compared to… education, social communications, ecommerce… “Why can’t we… ?”

• Not joined up• Systems don’t quite meet their needs• Others do it better• What did the GPs get right?

What does NHS England tell me?

• Make it safer• Spend less• Provide care closer to home

• Avoid unplanned admissions• Avoid planned admissions• Self-care• Third sector care• Remember social care

• Better care for patients with long-term conditions• Improve accountability and transparency

What do implementers tell me?(according to some other people)

• Luddite clinicians

• Information governance/ data protection etc

• Information systems: Legacy, new, cost, cost of change

• Split of primary and secondary care

• Data standards

• Burden of data collection

• Capacity of ICT staff

• Capacity in project management

• Capacity in clinical informatics

• Legacy of National Programme for IT

Barriers to improvement

• Organisational structures and assumptions

• The difficulty of identifying cash-releasing savings

• The last 5 metres to the bedside

• Dogmas that aren’t challenged

Opportunities from people

• Chief Clinical Information Officers, but more of them and more effective, and from all HCPs, and from commissioners

• Chief Information Officers

• Young practitioners• Practitioners who have worked elsewhere

• Professionalisation

• Enabled patients

Opportunities from technology

• Networked fixed computers

• Networked handheld computers

• Cloud services

• Autoidentification

• Everyday technology

• Better clinical information systems

NHS England: Big projects

• Technology Fund

• Nursing Technology Fund

• Digital Primary Care

• care.data

• NHS Choices

• Others

• What’s missing?

Technology Fund

• First round allocated• Very tight timing• Matched capital• Themes

• Computerised medicine management• Interoperability• Others

• Computerised document management• Portals

• Accelerator sites

Medicines management

• Computerisation of prescribing• Computerisation of administration

• The last 5 metres

• Inpatients: Transfer from and to primary care• Outpatients: Joint management

Unplanned care

• Navigating the system• Access to existing records• Adding the record of the unplanned encounter

• Working differently

Long-term conditions

• CIS that span all the organisations and settings of care• Smart systems that identify deterioration earlier• Managing investigations used for monitoring differently from those

used for diagnosis

• New suppliers

• Working differently

Reorganisation of specialist services

• Likely changes• Need for interoperability of CIS• Who is responsible in the new NHS structures?

Interoperability

• Integration/ Communication/ Interoperability

• What are the barriers?• Network technology and availability• Data standards• Organisational barriers

• Who is going to solve this?• Local• National• Suppliers

Handover

• Task-oriented views or systems• Persistence of tasks across time, distance, systems and organisations• Escalation on noncompletion

The last 5 metres (yards) to the bedside• Prescription• Administration of medicines• Requesting laboratory investigations• Blood transfusion• Data from monitoring devices• Point of care testing

• Handheld devices• Wireless networks (Survey etc)• Patient identification for procedures

Thank you

• http://www.england.nhs.uk

• [email protected]