The National Programme for IT

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The National Programme for IT
or NPfIT
One year further on and the National Audit Office
Report
Stephen Balmer
CPD4IT (Scotland) Meeting
8th November 2006
Wishaw General Hospital
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(No Transcript)
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• Retrospect

• The update

• What about Laboratories?

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What is the Purpose of the Programme?

• Huge volume of contacts between NHS and patients
  generating reams of paper records, reports and
  information.

In a typical week

• six million people will visit a GP,

• 360,000 people will have an x-ray,

• 250,000 people will attend their first
  outpatient appointment,

• pharmacists will dispense some 13.7 million
  items on NHS prescriptions.

• Procurement and development of IT within the NHS
  has been haphazard creating silos of data on
  individual systems.

• The Programme is an opportunity to use IT to
  reform the way the NHS in England uses
  information to improve the provision of health
  services to patients.

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What is the Programme how is it organised?

• National projects providing services for the
  whole of England.

• New National Network N3

• National Data Spine NHS Care Record Service

• Choose and Book

• Local Service Providers (LSPs) responsible for
  delivering the services within their particular
  part of the country.

• Providing and maintaining local NHS Care
  Records Service

• PACS solutions which connect to the National
  Spine in accordance with the NHS Care Record
  Service specification.

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Programme Organisation - Clusters
North East, Yorkshire Humberside
(Accenture/CSC) 7.5m Population 170,000 NHS Staff
North West West Midlands (Computer Services
Corporation) 12.3m Population 276,000 NHS Staff
East East Midlands (Accenture/CSC) 9.5m
Population 174,000 NHS Staff
London (British Telecom) 7.2m Population 165,000
NHS Staff
South (Fujitsu) 13.1m Population 249,000 NHS
Staff
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Programme Organisation - CfH
Department of Health (DoH)
Connecting for Health (CfH)
National Programme for IT (NPfIT)
National Application Service Providers (NASPs)
National Infrastructure Service Provider (NISP)
Cluster
Cluster
Cluster
Local Service Provider (LSP)
Local Service Provider (LSP)
Local Service Provider (LSP)
Strategic Health Authority
Strategic Health Authority
Strategic Health Authority
NHS Trust
NHS Trust
NHS Trust
NHS Trust
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Electronic NHS Care Records Service CRS
(Spine), N3, e-mail and Contact

• Detailed Care Record Records of individual
  clinicians recording their episodes of care.

• Summary Record NHS Number, name, date of birth,
  address, allergies, adverse drug reactions, major
  treatments (historic and ongoing). A summary
  record for first line care.

• Reduced administration and duplication of record
  keeping

• Securely accessible by Healthcare Professionals
  with Legitimate Relationship with patient.

• Patient can choose to limit their participation.

• Lynchpin and enabler for other key NPfIT
  components

• Safe, secure, encrypted e-mail and e-mail address
  book

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Choose and Book - CAB

• Realtime booking of hospital appointments
  allowing patients choice of date, time and place.

• Patients can walk away from GP surgery with
  appointment notification.

• Post consultation online or telephone facility to
  allow patients to make any required arrangements
  before selecting their hospital appointment.

• Vast improvement in the time taken for hospital
  appointment over traditional paper trail
  mechanism.

• Should significantly reduce did not attends

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Electronic Transmission of Prescriptions - ETP

• Prescriptions generated electronically and
  recorded in the patients CRS

• Patient can nominate a Pharmacy and the
  electronic prescription will be automatically
  sent there.

• ePrescription can be issued if patient wishes and
  which can be taken to any Pharmacy.

• Far safer for patient by virtue of electronic
  transfer or barcoded details.

• Benefit for Pharmacist in online reimbursement
  requesting after dispensing.

• Simplification of Repeat Prescription
  requirements.

• Integration with decision support system to
  assist clinician prescribing options.

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Picture Archiving and Communication System PACS
(RIS)

• Images available to all legitimate clinicians
  through CRS allowing current diagnosis and
  chronological review.

• Digital images of x-rays and scans available for
  distribution allowing common view of information
  for clinician and care team discussion across
  large geographical distances.

• Speedier diagnostic service with removal of
  manual processing delay of film based imaging.

• Safer and more efficient working environment for
  Radiography staff film is heavy and processing
  requires unfriendly chemicals.

• No more cancelled operations or procedures due to
  loss of or unavailability of diagnostic images.

• Digital technology significantly reduces patient
  exposure to radiation.

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So, what progress on last year - deployment

• By 3rd April 2006, the Programme had achieved the
  following

• 7,639 Choose and Book deployments

• 1,153 Electronic Prescribing Service deployments

• 9 Acute Patient Administration System
  Deployments

• 10 Mental Health Patient Administration Systems

• 17 Community Hospital Patient Administration
  Systems

• 106 Community Care Systems

• 30 Picture Archiving and Communication Systems
  deployments

• 607 other system deployments such as GP systems
  etc.

• Ongoing Implementation activity per month (CfH
  figures)

• 3 Patient Administration Systems

• 500,000 Patient Records converted and cleansed

• 200 NHS sites have systems upgraded

• 600 new N3 connections

• 14,000 smartcards issued

• 1,700 site visits in planning deployments

• 6 Picture Archiving and Communication Systems
  implemented

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So, what progress on last year - utilisation

• By 3rd April 2006, the Programme had achieved the
  following

• 726,843 prescriptions issued using EPS

• 261,893 Choose and Book bookings had been made

• over 20 million images stored using PACS

• 167,946 registered NHSmail users (80,000 are
  active?)

• 14,130 new N3 connections have been made

• 208,990 NHS staff have been registered for
  smart card issue

• Ongoing Service Provision per month (CfH figures)

• 8.5 million x-ray and other images stored

• 15 million patient-related messages transmitted
  via spine

• 1.8 million pathology results sent
  electronically to GPs

• 14 million e-mails sent using NHSmail

• 600,000 letters issued electronically to
  patients

• 1.3 million hits on Connecting for Health
  website

• 100 terabytes of data transmitted via N3
  network around 4.5 billion written pages

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In terms of the overall Programme

• National Network N3 implementation providing
  rapid, robust and secure network across the NHS

• Target 6000 sites connected by 31st March 2005
  - achieved

• Target 12,000 sites connected by 31st March
  2006 achieved 3 months early

• Target all 18,000 sites connected by 31st March
  2007 14,022 connected as at April 2006 (91.5
  of total) and on target.

• Total cost 530 million over 7 years.

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In terms of the overall Programme

• National Data Spine Holds summary information
  about every patient. Controls access to patient
  records. Supports transmission of information
  between systems. Provides anonymised data for
  research and healt trend analysis.

• Phase 1 Release 1 (P1R1) Development complete
  by June 2004, roll out complete by Dec 2004. This
  phase will install systems, hardware and software
  to form the framework to build future
  functionality including PDS, Transaction Messaing
  System and enabling technology for Choose and
  Book and Electronic Transmission of Prescriptions.

• Parts of P1R1 went live June 2004 as planned
  but other parts were not implemented until April
  2005, some 10 months late.

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In terms of the overall Programme

• National Data Spine Holds summary information
  about every patient. Controls access to patient
  records. Supports transmission of information
  between systems. Provides anonymised data for
  research and healt trend analysis.

• P1R2 Development complete by Dec 2004, roll
  out complete by June 2005. More complex business
  and message handling processes including clinical
  situations. Includes full Choose and Book
  functionality, outpatient clinic letters,
  inpatient discharge summaries, report of the
  single assessment for elderly people, diagnostic
  imaging and pathology results, screening results,
  recording of care episodes and routing of some
  orders for some blood tests and diagnostic images.

• P2R1 Timetabled for development complete by
  June 2005 and roll out complete by Dec 2006. This
  phase was planned to add National Service
  Frameworks assessment and review record,
  secondary uses of spine data, planning and
  recording of the total care journey integrated
  care pathways, full linking and electronic
  transfer of correspondence, pathology and image
  ordering and resulting and integration of dental
  services.

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In terms of the overall Programme

• National Data Spine Holds summary information
  about every patient. Controls access to patient
  records. Supports transmission of information
  between systems. Provides anonymised data for
  research and healt trend analysis.

• In Dec 2004, P1R1 and P2R1 releases were
  reorganised and replaced by a set of 5 software
  releases covering the functionality of these two
  releases, and the order in which functionality
  was to be delivered has been rephased. The
  revised set of releases for 2005 have been
  completed to the revised target. Release 5 was
  deployed from December 2005 but the payment to BT
  included a retention for the remaining defects
  within that release. Release 5 has since been
  delivered and paid for in full.

• For 2006 and 2007, the number of spine releases
  will be limited to 2 functional releases per year
  which the LSPs may take together if they would
  prefer.

• In essence, some 2 years delayed.

• Total cost 620 million over 10 years.

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In terms of the overall Programme

• Choose and Book Initially to enable electronic
  booking of first hospital appointments for a
  patient at a date, time and place convenient to
  them.

• Target for first booking June 2004.

• Software delivered on time, first booking
  achieved July 2004.

• Since then, however, uptake has been slower
  than expected and as of October 2005, was about a
  year behind schedule.

• By 3rd April 2006, booking volumes were
  growing, but still only approximately 12 of all
  possible bookings were being made through the
  application.

• Web based Choose and Book incompatible with
  Internet Explorer 7.0

• Total cost 64.5 million over 5 years

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In terms of the overall Programme

• NHSmail E-mail and national directory service
  for all staff across all NHS organisations in
  England

• Target service available by October 2004 -
  achieved

• Total cost 50-90 million over 9 years
  (depending upon useage)

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In terms of the overall Programme

• Electronic Prescription Service transfer
  prescriptions electronically from GPs and other
  prescribers to the chemist of pharmacist
  nominated by the patient and to the Prescribing
  Pricing Authority.

• Target first deployment by Feb 2005 - achieved

• Target Dec 2005, 50 of all sites should be
  capable of issuing Electronic Prescriptions and
  by December 2007 100 of all sites should be
  capable of issuing Electronic Prescriptions.

• By March 2006, 1,034 (out of 8,298) practices
  were technically live (ie. able to switch on) and
  296 were actually using the application. 148
  community pharmacies were technically live and 11
  were using the application.

• Two of the ten pharmacy system suppliers had
  received authority to roll out for their
  systems.

• Although usage grows fairly rapidly (260,898
  prescriptions by March 2006), there is much to do
  to meet the December 2007 target.

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In terms of the overall Programme

• Picture Archiving and Communications Systems
  (PACS) provide systems to capture, store,
  distribute and display static or moving digital
  medical images, such as x-rays.

• Target full deployment of 130 PACS by March
  2007

• Implementations delayed, however by April 2006,
  30 PACS had been deployed.

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In terms of the overall Programme

• Local Service Providers responsible for
  providing and maintaining the local NHS Care
  Record Service to all NHS care settings and for
  PACS solutions which connect to the National
  Spine in accordance with the NHS Care Record
  Service specification.

• North Eastern Cluster approximately 25 months
  behind schedule

• London Cluster approximately 14 months behind
  schedule

• Eastern and East Midlands Cluster
  approximately 21 months behind schedule

• Northwest and West Midlands Cluster on
  schedule with revised targets (most aspects
  revised to 12 months later) but with some
  functionality not being implemented until 19
  months behind schedule.

• Southern Cluster approximately 18 months
  behind schedule

• Total cost - 4998 million over 10 years.

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Engaging the Users
Ipsos MORI Survey July 2005
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What about Laboratories?

• Well nothing. but,

• Authentication and Authorisation

• Connectivity to the Personal Demographic Service
  (PDS)

• Legitimate Relationship

• Result reporting to Personal Spine Information
  Service (PSIS)

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Authentication and Authorisation

• Achieved via smart card access and NHS Userid
  Login

• Authentication, identity of user

• Authorisation, permission(s) to act in given
  capacities

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Personal Demographic Service

• The Personal Demogaraphic Service (PDS) is part
  of the NHS Care Record Service (NHS CRS), which
  will create an electronic care record for every
  NHS patient in England by 2010.

• Each persons electronic NHS Care Record will
  comprise both demographic information, such as
  name, address, date of birth and NHS number, and
  medical information. The PDS is the national,
  electronic database of demographic details. It
  will enable a patient to be readily identified by
  NHS staff and associated, quickly and accurately,
  with their correct medical details.

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Legitimate Relationship

• Exists between a patient and

• Workgroup(s),

• Individual clinicians.

• Only users within the Legitimate Workgroup can
  access the patient record.

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Personal Spine Information Service

• The Personal Spine Information Service (PSIS) is
  the central database containing clinical records
  for each NHS patient. The PSIS record provides an
  up to date summary of information and key events
  in a patients life and care drug allergies,
  operations, conditions, medication history as
  well as details of contacts with care providers.

• When current treatment generates essential
  information for continuing care, such as
  discharge information or notes of visit to a
  walk-in centre, specified summary information is
  added to the PSIS record. In this way the
  person-based PSIS record gives information to,
  and receives it from, many local systems as the
  patient experiences healthcare.

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Thank You !