https://nww.stuff.nhs.uk

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https//nww.stuff.nhs.uk

• Or Whither NHS net

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Why?

• Long personal involvement
• Central to all the changes that surround us
• Knowledge is power
• Pretending it isnt going to affect us is not an
  option

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Why?

• Not for coding clerks.
• Who dont have a long term future.
• Not just for the IT department.
• For us all, clinical workers and management
  workers alike.

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What?

• The NHS plan.
• Information for health.
• 1998
• Our LIS.
• Our local funding.
• Building the information core.
• Jan 2001.
• Other bits from all over.

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Strands in All This

• Communications
• Records
• Information

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Strands in All This

• Maybe money?

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New Ways of Working

• Not bolting computers onto existing practices
• About redesigning work
• Redesigning care
• New pathways in the jargon

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NET Targets

• Secondary care
• Clinical and support staff
• 25 have desktop access by now
• Really is 20 ish
• 100 by 2002

• Primary care
• GPs and managers
• 95 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 !
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Uses Now

• Email
• Net browsing
• Information source
• Fax out (doesnt 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.

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Security

• Lags behind
• Caldicott
• Awareness
• Safe havens etc etc
• National audit scheduled for Dec 2001
• To BS7799
• NHS cryptography
• Roll out spring 2002
• Public key encryption

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What Next? Uses of NHS net

• National priorities are pathology requests and
  reports.
• Then xray reports and requests.
• Booking.
• Discharge information.

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Jargon

• EPR
• Electronic Patient Record
• ? Attainable
• EHR
• Electronic health record
• ? Holy grail

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Clinical Terminologies

• Coding viz classifications
• Read 3
• Ends 2003
• SNOMED CT
• Starts 2003
• ? Legacy coding and classifications

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EPR Level 3

• Integrated patient master index.
• PAS.
• Departmental systems (all departments)
• Electronic clinical orders and results reporting.
• Prescribing software.
• Multi-professional care pathways.

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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 by 2003
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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.

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EPR Out of Hours

• National programme
• To make summaries of GP EPRs available 24 hours a
  day
• First to GP out of hours services
• Then to AE departments
• ?? 2005

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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.

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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!

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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.

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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.

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Information

• NICE
• NeLH
• Protocols
• Policies
• Guidelines
• HiMPs
• CHiMPs

And uncle tom cobbly.
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Payroll and HR

• A national payroll and HR system is planned to
  start rolling out in 2004.
• Doing away with individual organisational
  arrangements.

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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.

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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?

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Caveats

• How much extra time to spend capturing and
  structuring records?1 30 minutes plus per
  day.
• 1 Tierney et al JAMA 1993269379-83.

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Caveats

• Are we ready to share our information with
  patients ?
• The strategy says there are irresistible
  arguments for this.

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Caveats

• Control
• Governance
• Accreditation (and Re- )
• Performance related pay
• Politics
• Or just my depixol dose is late.

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A Personal Hope
Clinical Needs
Not
Technology for its own sake