The National Programme for Information Technology
What’s in it and what’s in it for anaesthetists?
SCATA Annual MeetingManchester, 13th November 2003
Prof P.HuttonChairman, Academy of Medical Royal Colleges
How did it all begin?
Where does the programmestart and stop?
Who pays for what?
Who does what?
The landscape of modern medicine
Patients and potential patients
CliniciansManagersPremises
Pace of changeLimitation of resourcesInformation transfer and storage
The scale of the taskThe scale of the taskIn one year:In one year:
617 million prescription items issued617 million prescription items issued
Approximately 300 million consultations in primary Approximately 300 million consultations in primary care care
13 million outpatient consultations13 million outpatient consultations
Over 5.3m people admitted to hospitalOver 5.3m people admitted to hospital
4 million operations4 million operations
NHS already spends £850m on IT each yearNHS already spends £850m on IT each year
What do different stakeholders want?
What do patient’s want?•Good care, advice and choice•Ease of booking•Prompt response•Keeping to time •Efficient transfer of data•Access to information
What do managers want?
To get information on:•Throughput•Cost•Quality•To run a happy hospital
What do clinicians want?To be able to see:•The right patient•In the right place•At the right time•With the right information But, just who is a clinician?
The functional objective
To ensure that whoever is making a health decision has available the right information at the right time
Not forgetting that this might be the patient, a carer or a manager as well as a clinician
Progress in clinical practice Major changes in 25 years
•Greatly improved diagnosis•Agreed management of common conditions•Team working (between specialties and with GPs)•Skill mix and non-medical roles
Consequences of information transfer
•More protocol driven care
•Does a consultant’s work start where protocols end?
Pressures on the demand-supply balance
•Demographics and longevity
•The changing medical workforce
•Public expectations
Why should we be bothered?
All these factors demonstrate that future demand for health care cannot be met by current delivery models
and, not only will teams be more important, the teams will depend on skill-mix and new ways of working
All specialties and all clinical and non-clinical staff will be affected. The public need to be given encouragement to be more self- sufficient
What is the clinical task?
•To keep people healthy
•To treat and manage those who are ill
National and regional issues
The Five NPfIT Clusters (NPfIT’s geographic grouping of Strategic Health Authorities)
3
life
The health information spine (I)
28 weeksgestation
death
clinical events
Unique identifier
3
life
The health information spine (II)
28 weeksgestation
death
Local records
Local records
Local records
Edited
Edited Edited
3
life
The health information spine (III)
28 weeksgestation
death
Asthma
Pregnancy
Diabetes
OutcomeComplications
FrequencyTherapy
DrugsResults
Current objectives and issues•A common ‘front-end’•Use of a unique identifier•Patient consent and personal information •IT infrastructure to support national applications (e.g. images)•Very basic, nationally accessible patient record (the NHS Care Record)•On-line booking & ETP
Tough problems•Unique identifier•Confidentiality•Consent•Access•Content of stored data•Existing records•Power shifts in relationships
Plus points•Makes a future NHS possible •Better use of scarce resources•Decision support for safer care•Increased clarity of purpose•Better access to records•Less frustration and time wasting•Improved patient experience•Valuable information database
Potential downsides•Suspicion of staff•Suspicion of public•Disbelief in success•Local support and maintainance•Loss of clinical autonomy•Power shifts in relationships•Disruptives and malcontents
What will the future look like?
•First point of contact non-medical•Many consultations not face to face•Many more non-medical people delivering care•More explicit that care is based on chance•Protocols used whenever possible•Patient access to records at any time•Less acute receiving sites•Less clinical freedom•Greater cost-effectiveness in decision making•Clear limitation on resources
The relevance to:•anaesthesia, •critical care and •pain
The NASPBetter historical dataGood for pre-operative assessmentGood for accessing resultsClinical support (prescribing and decisions)
The LSPMust provide for the NASP? Additional functionality
•Anaesthetic records
•Data sets
•Critical incident reporting
Where to from here?