TARGET 9/6/04 – The NPfIT and You

TARGET 9/6/04 – The TARGET 9/6/04 – The NPfIT and YouNPfIT and You

(Information and Technology (Information and Technology Solutions: Assessing and Solutions: Assessing and

addressing your own and the teams addressing your own and the teams IT needs.)IT needs.)

Dr Phil Griffin (IM&T Clinical Lead)Dr Phil Griffin (IM&T Clinical Lead)

Who Said This?Who Said This?

““By 2010, every NHS By 2010, every NHS patient in England will patient in England will

have an individualhave an individualelectronic NHS Care electronic NHS Care

Record”Record”

Dr John Reid, Secretary of State for Health, 8th Dec 2003

A Brief History of TimeA Brief History of Time Pre-1997 – The Dark AgesPre-1997 – The Dark Ages 1997 – All Change1997 – All Change 1998 – “Information For Health”1998 – “Information For Health” 2001 – “Building the Information Core”2001 – “Building the Information Core” 2002 – The Wanless Report2002 – The Wanless Report

More money. Lots more moneyMore money. Lots more money Central management of a National ProgrammeCentral management of a National Programme

2002 - 2002 - Delivering 21Delivering 21stst Century IT Support for the NHS Century IT Support for the NHS 2003 – The National Programme for IT is born and 2003 – The National Programme for IT is born and

History startsHistory starts 2004 – Clusters are born and a DOCTOR gets involved!2004 – Clusters are born and a DOCTOR gets involved!

WHAT DO THE FOLLOWING WHAT DO THE FOLLOWING HAVE IN COMMON?HAVE IN COMMON?

£265,000£265,000

NPfITNPfIT Richard GrangerRichard Granger

Acronym AssassinationAcronym Assassination DON’T say “EPR”DON’T say “EPR” DON’T say “EHR”DON’T say “EHR” DON’T talk about the “HRI”DON’T talk about the “HRI” Only say “IfH” if you’re really oldOnly say “IfH” if you’re really old Forget “ICRS” (as of 2/12/03)Forget “ICRS” (as of 2/12/03) If you’re hip and happenin, say:If you’re hip and happenin, say:

NHS Care Record NHS Care Record ServiceService

NPfITNPfIT A £2.3bn programme over three years to A £2.3bn programme over three years to

deliver four key elements:deliver four key elements:NHS Care Records ServiceNHS Care Records ServiceElectronic appointment bookingElectronic appointment bookingElectronic Transmission of PrescriptionsElectronic Transmission of PrescriptionsUnderpinning IT Infrastructure (N3)Underpinning IT Infrastructure (N3)

Best use to be made of the existing asset Best use to be made of the existing asset basebase

NPfIT is about patients and those who careNPfIT is about patients and those who carefor them, not technologyfor them, not technology

NPfIT Basic StructureNPfIT Basic Structure

The design and roll-out of the NHS Care Records The design and roll-out of the NHS Care Records Service has been organised into two parts:Service has been organised into two parts:

Services that are common to all users nationally Services that are common to all users nationally will be the responsibility of the National will be the responsibility of the National Application Service Provider (NASP). Application Service Provider (NASP).

Services delivered at a more local level will be Services delivered at a more local level will be the responsibility of five Local Service Providers the responsibility of five Local Service Providers (LSPs).(LSPs).

LSP ClustersLSP Clusters

Phase 1 - by end 2004Phase 1 - by end 2004

Booking of outpatient appointments onlineBooking of outpatient appointments online NHS email and access to online knowledgeNHS email and access to online knowledge Electronic laboratory and radiology resultsElectronic laboratory and radiology results Some clinical communications e.g. GP referral Some clinical communications e.g. GP referral

lettersletters Basic “spine” functionalityBasic “spine” functionality

Providing simple functionality andProviding simple functionality andmaking best use of existing systemsmaking best use of existing systems

Phase 2 - by end 2006Phase 2 - by end 2006

Access to a more detailed patient record Access to a more detailed patient record including: including: specialist resultsspecialist results GP prescribing recordGP prescribing record hospital discharge summarieshospital discharge summaries

Digital imagingDigital imaging Computerised referrals and requestsComputerised referrals and requests

Migrating on to active and interactive functionalityMigrating on to active and interactive functionality

Phase 3 - by end 2008 and Phase 3 - by end 2008 and continuingcontinuing

Working towards full integration of health and Working towards full integration of health and social services including:social services including: decision support softwaredecision support software screeningscreening community wide prescribingcommunity wide prescribing computer support for care planningcomputer support for care planning

Supporting advanced features e.g. telemedicineSupporting advanced features e.g. telemedicine

Continuing development and enhancementsContinuing development and enhancements

The Care Record ServiceThe Care Record Service

A mix of local and national IT services A mix of local and national IT services proving a cradle-to-grave NHS Care proving a cradle-to-grave NHS Care Record.Record.

Summary patient record; personal health Summary patient record; personal health information and demographic datainformation and demographic data

““The Spine”The Spine”

The Care Record ServiceThe Care Record Service

Applications at a local level provided by Applications at a local level provided by Local service Providers (LSP) Local service Providers (LSP)

Accenture (£930 million)Accenture (£930 million)Common national applications provided by Common national applications provided by

National Application Service Providers National Application Service Providers (NASP) (NASP)

BT (£620 million)BT (£620 million)

The Care Record ServiceThe Care Record Service

The NASP will provide software and The NASP will provide software and support for summary patient record, and support for summary patient record, and implement consistent security and implement consistent security and confidentiality principles.confidentiality principles.

A Transaction Messaging System (TMS) A Transaction Messaging System (TMS) and an Access Control Service (ACS)and an Access Control Service (ACS)

The Care Record ServiceThe Care Record Service

The Local Service Provider (Accenture) The Local Service Provider (Accenture) will act as system integrators, supplier will act as system integrators, supplier managers and programme managers for managers and programme managers for the clustersthe clusters

They will ensure systems are spine-They will ensure systems are spine-compliant and deliver hardware and compliant and deliver hardware and software replacements and implement software replacements and implement core local trainingcore local training

Got it? If not, just remember…Got it? If not, just remember…

The Care Record Service is a The Care Record Service is a really, really GOOD IDEA.really, really GOOD IDEA.

E-Booking (oh no!)E-Booking (oh no!)

Choice is a main driver behind eBookingChoice is a main driver behind eBookingPatients will choose from a number of Patients will choose from a number of

options including which hospital, and options including which hospital, and when, they would like to attendwhen, they would like to attend

Booking will be made at point of referralBooking will be made at point of referral

ORORLater on through a Booking Management Later on through a Booking Management

Service (BMS)Service (BMS)

E-BookingE-Booking

Contract with Atos OriginContract with Atos OriginFirst bookings this year, then six phasesFirst bookings this year, then six phasesAll surgeries by Dec 2005All surgeries by Dec 2005

Three Other Things…Three Other Things…

Electronic Transfer of PrescriptionsElectronic Transfer of PrescriptionsN3 – bigger, faster, betterN3 – bigger, faster, betterNHSmail – a lifelong secure email address NHSmail – a lifelong secure email address

for all NHS staff.for all NHS staff.

So email me at [email protected] email me at [email protected]

The Bluffers Guide to the National The Bluffers Guide to the National ProgrammeProgramme

Know the 4 areas – NHSCRS, eTP, e-Booking, Know the 4 areas – NHSCRS, eTP, e-Booking, InfrastructureInfrastructure

““NPfIT” = “En Pee fit”NPfIT” = “En Pee fit” Remember the small “f” or lose all street credRemember the small “f” or lose all street cred Practice saying “LSP clusters” and remember “East Practice saying “LSP clusters” and remember “East

Midlands and East of England”. (Forget the rest)Midlands and East of England”. (Forget the rest) Mug up on AccentureMug up on Accenture Express enormous sympathy to any Celtic friendsExpress enormous sympathy to any Celtic friends Ask you colleagues if their systems are “spine-compliant”Ask you colleagues if their systems are “spine-compliant” Say “NHS Care Record Service” a lot, especially in Say “NHS Care Record Service” a lot, especially in

meetingsmeetings Let as many people as possible know you’ve got an Let as many people as possible know you’ve got an

NHSmail address and actually use itNHSmail address and actually use it

What does this mean for General What does this mean for General Practice?Practice?

the LSP:the LSP:Phased introduction of “new solution” over Phased introduction of “new solution” over

few yearsfew yearsSpine compliantSpine compliantCentral serversCentral servers Info across N3Info across N3Data exchange with acute trust/community Data exchange with acute trust/community

clinics etc; support SAPclinics etc; support SAP

What does this mean for General What does this mean for General Practice?Practice?

Choice of solution between two (nGMS Choice of solution between two (nGMS says three)says three)

Second TBA by OctoberSecond TBA by October In theory no compulsion to change. In theory no compulsion to change.

BUT……BUT……Contract also states “no loss of Contract also states “no loss of

functionality”functionality”BMA GuidanceBMA Guidance

So What’s Going On Locally?So What’s Going On Locally?

The SHA has controlThe SHA has control The Chief Information Officer is therefore a Very The Chief Information Officer is therefore a Very

Important Person (Mike O’Brien)Important Person (Mike O’Brien) The LIS Project – evolved and perishedThe LIS Project – evolved and perished ISSGs (4 quadrants + 1 SHA)ISSGs (4 quadrants + 1 SHA) The Herts Health Informatics Service (HHIS) is The Herts Health Informatics Service (HHIS) is

expanding and evolvingexpanding and evolving June Dodds is our Project ManagerJune Dodds is our Project Manager No GPs want to join in yetNo GPs want to join in yet

Even More Locally…Even More Locally… We have 14 Practices:We have 14 Practices:

9 EMIS9 EMIS 3 IPS3 IPS 1 Torex1 Torex

Some are paperlessSome are paperless We have numerous scattered community sites, some poorly connectedWe have numerous scattered community sites, some poorly connected NSF-driven PCT initiatives especially CHDNSF-driven PCT initiatives especially CHD All main GP surgeries are on the NHSNetAll main GP surgeries are on the NHSNet All have pathology messagingAll have pathology messaging We have an IM&T manager and a Data Quality Facilitator (Assorted We have an IM&T manager and a Data Quality Facilitator (Assorted

Roz/s’s)Roz/s’s) Our PCT IM&T Strategy is doneOur PCT IM&T Strategy is done Our Data Quality Strategy is doneOur Data Quality Strategy is done Our IM&T Committee meets regularly and with HertsmereOur IM&T Committee meets regularly and with Hertsmere We have strong links with the SHA ISSGWe have strong links with the SHA ISSG We have implemented Network Managed ServicesWe have implemented Network Managed Services

What Have We Got To Do?What Have We Got To Do?

Increase funding earmarked for IM&TIncrease funding earmarked for IM&T Get the Community staff and branch surgeries Get the Community staff and branch surgeries

connectedconnected PCT ownership and full funding of Primary Care IM&TPCT ownership and full funding of Primary Care IM&T Convergence of Primary Care data qualityConvergence of Primary Care data quality PCT-wide standard auditingPCT-wide standard auditing Move away from practice-based serversMove away from practice-based servers Evolution towards the Care Record Service in co-Evolution towards the Care Record Service in co-

operation with our LSPoperation with our LSP Development and enhancement of support and Development and enhancement of support and

maintenancemaintenance

OK – HOW???OK – HOW??? InvestInvest PCT-wide standards in Information GovernancePCT-wide standards in Information Governance Work with the HHIS on the community and Work with the HHIS on the community and

branch surgery networkingbranch surgery networking Expand Network Managed Services to all PCT Expand Network Managed Services to all PCT

practices, along with other PCTspractices, along with other PCTs MSD Audit ToolMSD Audit Tool Data Quality StrategyData Quality Strategy TrainingTraining Understand the New GMS ContractUnderstand the New GMS Contract

A Vision of the Future…A Vision of the Future… Money. Lots and lots of moneyMoney. Lots and lots of money A true broadband NHSnet infrastructureA true broadband NHSnet infrastructure Standardised medical record coding across the NHSStandardised medical record coding across the NHS All clinicians have access to the information they need to knowAll clinicians have access to the information they need to know Practices free to use whichever front-end they like, from a nationally Practices free to use whichever front-end they like, from a nationally

approved listapproved list Standardised note summarisationStandardised note summarisation Patient record held in Primary Care and on the “Spine”Patient record held in Primary Care and on the “Spine” Messaging in from secondary careMessaging in from secondary care GP to GP transfer seamless and 100% via the “Spine”GP to GP transfer seamless and 100% via the “Spine” Web-based access to medical records for patients and health Web-based access to medical records for patients and health

professionalsprofessionals Many web-based services for patientsMany web-based services for patients GPs able to web-access secondary care databases and vice versaGPs able to web-access secondary care databases and vice versa E-everything – booking, prescribing etc.E-everything – booking, prescribing etc.

Will It Work?Will It Work?

There is a real needThere is a real needThere is real central strong driveThere is real central strong driveThere is available fundingThere is available fundingThe benefits are almost incalculableThe benefits are almost incalculableThere’s political will, possibly motivated There’s political will, possibly motivated

by…by………a General Electiona General Election

Director General of NHS IT, Richard Granger said:

"Patients will see a modern, IT-enabled NHS, "Patients will see a modern, IT-enabled NHS, every time they come into contact with the every time they come into contact with the service. They will benefit from coordinated,service. They will benefit from coordinated,convenient and integrated care that places convenient and integrated care that places them at the heart of the NHS.”them at the heart of the NHS.”

For Coalface CliniciansFor Coalface Clinicians

Proceed to “paperless” record keepingProceed to “paperless” record keepingUse the new GMS Q&OF to improve your Use the new GMS Q&OF to improve your

codingcodingConsistent data recording across the Consistent data recording across the

practicepractice Information GovernanceInformation Governance

Information GovernanceInformation Governance

How does the practice handle, share and How does the practice handle, share and secure confidential information?secure confidential information?

Caldicott GuardianCaldicott GuardianWritten protocolsWritten protocolsStaff trainingStaff trainingAudit and reviewAudit and reviewUse the toolkit…Use the toolkit…