NHS IM

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NHS IMT Project Connect

• Keith J Oswin
• Dir of IT Northampton General Hosp
• Project Connect Facilitator 1999-2002
• NHS Connect Facilitator 2002-?
• NHS Exec South East

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Presentation Objectives

• Current Organisational Framework
• Governments Vision
• 1998-2005 IMT Strategy
• Impact of National Plan July 2000
• Project Connect where is it now
• Project Connect What Next NHS Connect

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INTRODUCTION

• Worked in the NHS for 37 years
• Background in Nursing
• Member BCS
• For the last 18 years worked in IT
• A Patients Perspective (We get ill)
• Project Connect July 1999-March
• NHS Connect April 2002

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CHANGES IN GOVERNMENT

• Over the last 5 years
• Competition ? Equity
• Marketforces ? Collaboration
• Independence ? Communities
• Administrative Processes ? Patient Centred Care
• ? More Funding (for I.T)
• Budget 2002?

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STRUCTURAL CHANGE

• From 1948
• Independent General Practitioners
• 1992 to 1997 Purchaser/Provider
• Health Authorities were responsible for
  everything then
• Hospital Trusts were established
• Health Authorities became commissioners
• In Primary Care
• GP Fundholding
• Big investment in admin systems
• Fierce resistance from some GPs
• Strong support from some GPs then
• Total Purchasing

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STRUCTURAL CHANGE

• From 1997 to 2002
• In Primary Care
• GP Commissioning established then abandoned
• GP Fundholding abolished
• Personal Medical Service Pilots established
• Primary Care Groups established
• Primary Care Trusts followed
• Care Trusts proposed
• NHS Direct and Walk-In Centres
• Development of Health Communities approach to
  I.T.
• Strategic Health Authorities
• 4 Regional Directors of Health and Social Care

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THE e-GOVERNMENT VISION

• The challenge for the NHS is to harness the
  information revolution and use it to benefit
  patients. Rt. Hon. Tony Blair 2nd July 1998
• modernised, efficient government, alive to the
  latest developments in e-business, and meeting
  the needs of citizens and businesses
• presenting Government as an integrated, modern
  organisation to the citizen
• More personalised services
• More Money Faster delivery and targets are
  required to deliver change
• The Private Sector can help with I.T. (and the
  public sector needs help)

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IT STRATEGY IN THE NHS

• 1992 Getting Better with Information
• 1997 The New NHS
• 1998 Information for Health
• 2000 E-Government Strategy
• 2000 The NHS Plan
• 2001 Building the Information Core
  Implementing the NHS Plan

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Information for Health

• An Information Strategy for the Modern NHS
  1998-2005

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Purpose of the strategy

• To put in place over the next seven years the
  people, the resources, the culture and the
  processes necessary to ensure

• NHS clinicians and managers have the information
  needed to support the core purpose of the NHS
• the public and patients have a range of quality
  information easily accessible about health and
  health services

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Specific targets

• an agreed security model
• a robust framework of national standards
• secondary care EPR
• lifelong Electronic Health Records
• 24hr access to records and information
• a National Electronic Library for Health
• public access to on-line information
• reliable information for management and planning

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National IMT infrastructure

• NHS number
• NHS-wide networking
• NHS-wide Clearing Service
• Security and confidentiality
• NHS Strategic Tracing Service
• National Electronic Library

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1998 to 2000

• ensuring the NHS copes with the millenium (Year
  2000) problem
• developing initial costed Local Implementation
  Strategies (and agreeing them with Regional
  Offices)
• completion of essential infrastructure
• connecting all computerised GP practices to
  NHSnet
• offering NHS Direct services to the whole
  population
• completing the national NHS email project
• establishing local Health Informatics Services
• completion of the cancer information strategy
• beacon EHR sites complete plans

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2000 to 2002

• 35 of all acute hospitals to have implemented a
  Level 3 EPR
• substantial progress in implementing integrated
  primary care and community EPRs in 25 of Health
  Authorities
• use of NHSnet for appointment booking, referrals,
  radiology and laboratory requests/results in all
  parts of the country
• community prescribing with electronic links to
  GPs and the Prescription Pricing Authority
• telemedicine and telecare options considered
  routinely in all Health Improvement Programmes
• a National Electronic Library for Health
  accessible through local intranets in all NHS
  organisations
• information strategies as appropriate to underpin
  completed National Service Frameworks
• beacon EHR sites have an initial first generation
  EHR in operation

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By 2005

• full implementation at primary care level of
  first generation person-based Electronic Health
  Records
• all acute hospitals with Level 3 EPRs
• the electronic transfer of patient records
  between GPs
• 24 hour emergency care access to patient records

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The NHS PLAN (2000)- Key Outcomes

• For the Health Service
• Reduced waiting times
• Convenient appointment times and pre-booking
• Access to 24 hour primary care within 48 hours
• Improved overall patient satisfaction, namely
  with respect to cleanliness and food in hospitals
• Reduced mortality rates for major killers
• Narrow the socio-economic health gap
• Monitor and benchmark NHS organisations with
  respect to
• fair access
• quality
• responsiveness
• In Partnership with Social Services
• better pre-admission and rehabilitation care for
  older people
• increased participation of drug users in drug
  treatment programmes

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IT TO SUPPORT THE NHS PLAN

• Investment
• 200 million currently being invested to
  modernise IT systems
• An additional 250 million in 2003/04
• Targets
• Electronic booking of appointments for patient
  treatment by 2005
• Access to personal medical records by patients by
  2004, as implemented by
• 75 of hospitals
• 50 of primary care
• All GPs connected to the NHSnet by 2002
• All local health services to have facilities for
  telemedicine by 2005

• The NHS will have the most up-to-date information
  technology systems to deliver services faster and
  more conveniently for patients.
• The NHS Plan paragraph 4.21

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THE NEW ENVIRONMENT

• Corporate Governance
• All NHS bodies controlled under NHS Trust status
• Clinical Governance
• All NHS clinicians must meet minimum standards
• Commitment to seamless care
• Improved communications between primary and
  secondary care
• Integration social services and formation of
  Community Care Trusts
• Improved Access to primary care
• NHS Direct and Walk-in centre
• Patient-centred and personalised

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IMPLEMENTING THE INFORMATION CORE January 2001

• The necessary information and IT infrastructure
  to support the patient centred delivery of care
  and services
• Building on and updating Information for Health
• Providing a clearer focus on priorities
• Describing what needs to be delivered over the
  next few years
• A more robust approach to standardisation

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SERVICES DESIGNED FOR PEOPLE
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IMPLEMENTING THE INFORMATION CORE - Timetable

• March 2001
• 95 of GP practices and 25 of NHS trust staff
  with access to NHS information services
• March 2002
• desktop connections for NHS clinical staff with
  access to e-mail, web-browsing and directory
  services
• start of cryptography support programme
• All Consultants to be connected by 09/02 (new
  target)
• March 2003
• migration to national standards for office
  systems
• Use of SNOWMED clinical terms
• March 2004
• major payroll/HR system implemented
• March 2005
• e-record transfer in primary care, Level 3 EPR,
  Level 1 EHR
• fully networked NHS

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DEVELOPING THE NEW NATIONAL INFRASTRUCTURE
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NETWORKS FOR HEALTH- NHSnet

• Secure national network/intranet for health
  services
• Supports e-mail, messaging and browsing with
  gateways to the internet
• Devised in the early 1990s
• Was not used seriously until 1999
• Supplied by BT and Cable Wireless
• Due for re-procurement by 2002
• Racal Healthlink

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GPnet

• In the Beginning
• Structure
• Connections
• Ways of Working
• Tracking Database
• Pathology Messaging Enabler
• Regional Facilitatores
• Problems Encountered

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Problems Faced

• Capital Costs to GPs
• NHSnet Perceived Problems
• Supplier Commitment
• X.400 Address book Management
• ISDN Costs the Horror stories

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Project ConnectThe Business Case for Connecting
GPs

• The Project Connect case for connecting GPs was
  450,000,000 over 7 years
• The first national business case
• Had to work at all levels local, regional and
  national
• Was high risk and requires a leap of faith
• Required guaranteed delivery of benefits for
  patients and the NHS
• Had to consider the world outside health

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THE BUSINESS CASE Cost, Risk and Benefit

• Cost
• Connections lines, routers, installations
• Practice infrastructure LANs, workstations
• Network usage call charges, rentals, messaging
• Support training, programme costs
• Risk
• Supplier performance
• Technology lock-in keeping pace
• Not achieving targets
• People cant or wont use systems
• Benefits
• Had to be quantifiable financially difficult
  for infrastructure

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PROJECT CONNECT The Scope

• Over 9,000 GP practices
• Approximately 37,000 GPs
• Almost 100 Health Authorities (and over 600 PCGs)
• Probably 40,000 other staff in general practice
• Almost 300 hospitals with pathology laboratories

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SYSTEMS IN GENERAL PRACTICE

• 8,882 computerised practices
• 36 clinical system suppliers
• 3 suppliers cover 7,306 practices
• 15 suppliers cover 48 practices between them
• 1 supplier has 22 different clinical systems !
• 68 different clinical systems
• This is not a well managed environment

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CONNECTING PEOPLE

• Is more than just an I.T. issue
• Is a threat to organisations/people that dont
  want to change
• We did it the wrong way round we built the
  network before the applications
• Is very expensive
• Especially without national standards
• Security
• data

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CONNECTING PEOPLE- Cultural Change Issues

• Moving to electronic working
• The impact of e-mail
• Recognising personal fears
• Supporting the un-connected
• Maintaining the independence of GPs
• Whole system re-engineering
• Managing risk in connected systems

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AN EXAMPLE The Impact of e-Mail

• Increasing personal pressure
• Pace and the facility to cc the world
• Exposing personal fears
• Misunderstanding - enabling serious disagreement
• The need to re-engineer the person and the
  organisation
• The need for whole communities to move
• Security, confidentiality, audit trails

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Performance Monitoring
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Performance Monitoring
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National Position
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BEYOND PRIMARY CARE Hospitals

• So far our main programme has been focussed on
  Primary Care
• The hospital environment is more complex
• The systems are very different
• The people are different too e.g. attitude to the
  use of computers
• 50M Hardware SW Direct to Organisations
  (level playing field)

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Project Connect Progress
At 31st March 2002 98 8589 practices
connected 97 8470 practices have working e-mail
97 8470 practices have LANs 95 Have LANs
connected to NHS Net 98 Patients are with
Practices having NHSnet Access Working
Email
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How We Could Have Done It Better

• Have secure national network in place providing
• Latest technology standards with flexibility
• Best possible service levels
• Unlimited bandwidth on demand
• National directory service
• Make access to and use of the network free to
  users and cheap for the NHS
• Ensure that applications are designed to take
  advantage of a networked environment
• Define and control core technologies right down
  to the desktop
• E-mail
• Messaging
• Operating systems
• National messaging strategy based on strongly
  enforced national data model
• More attention to baselines
• Try to manage Supplier Capacity and Performance

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Future Developments

• Pathology Messaging (x.400,Edifact)
• Radiology Results
• XML Migration
• Practice Re-engineering( Virtual Reception etc)
• Electronic Referral (on line booking )
• Encryption Services
• Electronic Prescribing

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NHS Connect
son of project connect
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Agenda

• IT infrastructure strategy, policy and change
• Developments
• Messaging, email and directories
• Security and confidentiality
• NHSnet and the future of NHS networking
• IT infrastructure priorities
• PCT activities

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Drivers for change

• Policy context
• e-government
• the NHS Plan
• UK Online
• NHS information strategy
• Information for Health
• Building the Information Core
• User expectations
• Public expectations
• Technological developments

www.doh.gov.uk/ipu
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NHS Infrastructure SOC

• A major change from the existing network
  contracts
• A richer set of infrastructure services
• A whole system view, end to end
• Commonality to remove barriers in communication
  and incompatibility between systems
• Issues considered
• Mandate v. Earned Autonomy
• National Standards v. Local Flexibility
• Security v. Openness
• Present v. Future
• Infrastructure to support national applications

http//www.doh.gov.uk/ipu/whatnew/infrasoc.pdf
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Thick infrastructure
Technical standards
Ethical and legal requirements
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Service Change - out with the old in with the
new

• Changing business, technology and environment
• 2.5 million emails a day and growing
• 400,000 entries in ABS Online
• Withdrawal of Kermit Messaging (gt1M
  messages/month)
• Closure of Healthlink service
• Electronic Government Interoperability Framework
  (eGIF)
• eSMTP migration

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Email and Directory Services
Workflow Applications
Managed services
Managed e-mail
Web hosting




Analytical Services
e-learning
Information Services
Generic tools
e-mail

Browser

Productivity Tools
Office Systems
Analytical Tools
Core services
Messaging




Applications Data Centres
Call Centres Help Desks
ICT training
ICT support
Access and security
PKI and cryptography
Directory services


Virus protection
Certification Authority
Disaster Recovery
Access Control
Wide Area Networking
Physical network





Voice Networks
Mobile Connections
Video Conferencing
Local Area Networks
Other Access Channels
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.nhsmail - what were looking for ...

• Hosted mail service
• Mail service for largest organisations
• Directory service for whole NHS
• Improved user experience of mail
• Service for non-office-based staff
• Improved resilience particularly for small sites
• Better cross-organisation and community team
  working
• Correct contact information across service

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.nhsmail and directory central procurement
progress

• Two shortlisted suppliers
• EDS
• Syntegra
• Resolve to preferred bidder by end of April 2002
• Prepare Full Business Case for approval
• Award contract
• Initial service implementation late Summer 2002
• Complete roll out to ALL NHS organisations by
  2004

nww.nhsia.nhs.uk/nhsnet
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Security and Confidentiality

• Privacy Enhancing Technologies (PET)
• Outline Business Case for national procurement
• Guidance for local procurements
• BS7799
• Threat and risk assessment
• Vulnerability assessment
• Virus Protection
• National solution at the gateway
• National solution on the network
• Local solution at the desktop

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Networking the NHS
Managed e-mail
Managed services
Web hosting
e-learning
Information Services
Analytical Services
Workflow applications
Generic tools
e-mail
Office systems
Productivity tools
Browser
Analytical tools
ICT training
ICT Support
Call Centres/ Help desk
Core services
Messaging
Application/ data centres
Disaster recovery
Access control
Access and security
PKI and cryptography
Directory services
Certification Authority
Virus protection
Physical network
Wide area network
Local area networks
Voice networks
Mobile connections
Other access channels
Video conferencing
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NHSnet a history
Conceived in

• 1992 a private, secure network
• connecting hospitals (trusts) and Health
  Authorities
• administrative data
• contracting, fundholding information
• central returns

approx 300 organisations
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Where we are heading . . .
Government DoH
Social Services Other local agencies
Internet
GSI
Internet gateway
Universities
JANET
Pharmacies Housing Education Schools Libraries Opt
itians
Teaching hospitals (40)
Strategic HAs (30) Regional Offices DoH
GP practices (20,000)
Hospitals PCTs Community Trusts (500)
Local VPNs (virtual private networks)
Social Services Other local agencies
Regional broadband initiatives
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Who else wants to be connected?

• Social Services
• Community Pharmacists
• Dentists
• Voluntary Sector Hospices
• Prison Health Services
• Private Hospitals providing NHS services

• Public Health Observatories
• Local Medical Committees
• GP Co-operatives
• Opticians
• Out of Hours Centres

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Strategic Outline Case -Infrastructure
Connectivity Targets
NHS organisations to connect all clinical and
other relevant staff to NHSnet for basic email
and web browsing by March 2002 100 of GP
practices computerised and connected with desktop
access to NHSnet by March 2002 Access to NHS
Address Book directory for all connected staff by
March 2002 Networked desktop PC access for all
consultants by September 2002 NHS organisations
to connect all staff to NHSnet by March 2003
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GP Connections Achievements and Outcomes
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Is the GP infrastructure being used?

• Progress on acceptance testing
• Increased usage and traffic on NHSnet dramatic
  increased since March 2000
• Demand for more bandwidth
• Demand for security and encryption products and
  advice
• Demand for 24/7 support
• Demand GP to GP record transfer
• Demand for more clinical messaging
• More noise when things go wrong and dont work!

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Volume of Messages
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Primary Care Trust Network issues

• Funding of NHSnet connection (up to 256k)
• Security of NHSnet connection
• Code of Connection
• BS7799
• Virus Protection
• MessagingSubmission of Address Book entries
• eSMTP Migration
• Migrations
• Healthlink
• ESMTP
• IP Addressing

http//nww.nhsia.nhs.uk/nhsnet
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PCT activities on behalf of GPs

• Local standardisation
• Local procurement
• Software
• Networked Hardware
• Network Management
• Managed Services and Applications
• Caldicott Guardian
• Submission of Address Book entries
• Managed email Service

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NHS Connect Connectivity Performance Monitoring

• Number of clinical and other relevant staff
• Number of clinical and other relevant staff
  connected to NHSnet
• Number of clinical and other relevant staff to be
  connected to NHSnet through the managed email
  service
• Number of devices available for connection to
  NHSnet