Information For Health An Information Strategy for the Modern NHS 19982005

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Information For Health An Information Strategy
for the Modern NHS (1998-2005)
Denis J. Protti University of Victoria School of
Health Information Science Calgary Regional
Health Authority July 22, 1999
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Outline

• Background - 1991 to 1997
• 1998 Reforms
• New IMT Strategy
• Strategic Objectives Targets
• Electronic Records
• Timelines
• Action Statements

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1991 NHS Reforms

• 1990 White Paper - Working for Patients
• Created an internal market
• Set hospitals up as self-governing trusts
• Established GPs as fundholders
• Introduced contracts
• 1991 White Paper - Patient's Charter
• 1992 White Paper - Health of the Nation

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1992 NHS IMT Strategyfive key principles

• Information will be person based
• Systems should be integrated
• Information will be derived from operational
  systems
• Information must be secure and confidential
• Information will be shared across the NHS

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1998 ReformsChange in Direction

• Labour Party elected May 1997
• 3 key policy documents by early 1998

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Policy Document 1 The New NHS

• ambitious ten-year programme for the
  modernisation of the NHS
• 1 billion from red tape into patient care
• NHS Direct - 24-hour nurse helpline
• NHS information superhighway
• guaranteed fast-track cancer services

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The New NHS Policy Objectives

• To improve health and reduce inequality
• To provide integrated services
• To improve quality and responsiveness and raise
  standards
• To improve performance and efficiency
• To enable staff to maximise their contribution
• To improve public confidence in the NHS and
  social services

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Vision of a modernised NHS

• A national service
• Fast and convenient
• Of a uniformly high standard
• Designed around the needs of patients, not
  institutions
• Efficient, so that every pound is spent to
  maximise the care for patients
• Making good use of modern technology and know-how
  
• Tackling the causes of ill health as well as
  treating it

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The New NHS

• White Paper sets out three areas for action to
  drive quality into all parts of the NHS
• national standards and guidelines for services
  and treatments
• local measures to enable NHS staff to take
  responsibility for improving quality
• and a new organisation to address shortcomings.

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The New NHS

• teams of local GPs and community nurses working
  together in new Primary Care Groups to shape
  services for patients, concentrating on the
  things which really count - prompt, accessible,
  seamless care delivered to a high standard
• explicit quality standards in local service
  agreements between Health Authorities, Primary
  Care Groups and NHS Trusts, reflecting national
  standards and targets
• a new system of clinical governance in NHS Trusts
  and primary care to ensure that clinical
  standards are met, and that processes are in
  place to ensure continuous improvement, backed by
  a new statutory duty for quality in NHS Trusts.

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The New NHS

• new evidence-based National Service Frameworks
• to help ensure consistent access to services and
  quality of care right across the country
• will bring together the best evidence of clinical
  and cost-effectiveness, with the views of service
  users, to determine the best ways of providing
  particular services.
• a new National Institute for Clinical Excellence
  to give a strong lead on clinical and
  cost-effectiveness, drawing up new guidelines and
  ensuring they reach all parts of the health
  service.

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The New NHS

• A new Commission for Health Improvement will be
  established to support and oversee the quality of
  clinical services at local level, and to tackle
  shortcomings. It will be able to intervene where
  necessary.
• For the first time funding for all hospital and
  community services, prescribing and general
  practice infrastructure will be brought together
  into a single stream at Health Authority and
  Primary Care Group level.
• By requiring NHS Trusts to publish and benchmark
  their own costs on the same basis, the new
  arrangements will give Health Authorities,
  Primary Care Groups and the NHS Executive a
  strong lever with which to tackle inefficiency.
  

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The New NHS

• There will be clear incentives to improve
  performance and efficiency. Health Authorities
  which perform well will be eligible for extra
  cash. NHS Trusts and Primary Care Groups will be
  able to use savings from longer term agreements
  to improve services for patients.
• There will be clear sanctions when performance
  and efficiency are not up to standard. Health
  Authorities will be able to withdraw freedoms
  from Primary Care Groups. They, in turn, will
  have a range of new powers to lever up standards
  and efficiency at local NHS Trusts and as a last
  resort will be able to change provider if, over
  time, performance does not meet the required
  standard.

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The New NHS

• In 1998, the Government will publish a new
  Information Management and Technology Strategy
  for the NHS which will harness the enormous
  potential benefits of IT to support the drive for
  quality and efficiency in the NHS by
• making patient records electronically available
  when they're needed
• using the NHSnet and the Internet to bring
  patients quicker test results, on-line booking of
  appointments and up-to-date specialist advice
• providing knowledge about health, illness and
  best treatment practice to the public through the
  Internet and emerging public access media (e.g.
  digital TV)
• developing telemedicine to ensure specialist
  skills are available to all parts of the country

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Policy Document 2 Our Healthier Nation

• sets out proposals for concerted action by the
  Government as a whole in partnership with local
  organisations, to improve people's living
  conditions and health.
• recognises that there are limits to what
  Government can do and spells out what the
  individual can do, if the Government do their
  bit.
• proposes a 'contract for health'.

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Policy Document 3A First Class Service

• a framework for quality improvement and fair
  access in the NHS, the main elements of which
  are
• clear national standards for services and
  treatments, through National Service Frameworks
  and a new National Institute for Clinical
  Excellence
• local delivery of high quality health care,
  through clinical governance underpinned by
  modernised professional self-regulation and
  extended lifelong learning
• effective monitoring of progress through a new
  Commission for Health Improvement,
• a Framework for Assessing Performance in the NHS
• a new national survey of patient and user
  experience.

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Changes to the NHS
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Information for Health

• An Information Strategy for the Modern NHS 1998 -
  2005

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Information for Health

• released September 24, 1998
• http//www.imt4nhs.exec.nhs.uk/index1.htm
• written by Frank Burns, CEO, Wirral NHS Trust
• The challenge for the NHS is to harness the
  information revolution and use it to benefit
  patients
• Rt. Hon. Tony Blair
• All Our Tomorrow's Conference, Earls Court, 2
  July 1998

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The New Information Strategy

• The purpose of the new information strategy is
  to put in place over the next seven years the
  people, the resources, the culture and the
  processes necessary to ensure that NHS clinicians
  and managers have the information needed to
  support the core purpose of the NHS in the care
  of individuals and the improvement in public
  health.
• Section 1.24

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• The new Strategy will be based on the
  fundamental premise that good clinical and
  service performance management information will
  only flow if the strategy is focused on
  delivering the information required to support
  day-to-day clinical practice.
• section 1.32

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Strategy principles

• Information will be person based
• Systems will be integrated
• Management information will be derived from
  operational systems
• Information will be secure and confidential
• Information will be shared across the NHS

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Strategic information objectives (6)

• To ensure patients can be confident that the NHS
  professionals caring for them have reliable and
  rapid access, 24 hours a day, to the relevant
  personal information necessary to support their
  care
• To eliminate unnecessary travel and delay for
  patients by providing remote on-line access to
  services, specialists and care, wherever
  practicable
• To provide access for NHS patients to accredited,
  independent, multimedia background information
  and advice about their condition

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Strategic information objectives

• To provide every NHS professional with on-line
  access to the latest local guidance and national
  evidence on treatment and the information they
  need to evaluate the effectiveness of their work
  and to support their professional development
• To ensure the availability of accurate
  information for managers and planners to support
  the local Health Improvement Programmes and the
  National Performance Framework.

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Strategic information objectives

• To provide fast and convenient access for the
  public to accredited multimedia advice on
  lifestyle and health, and information to support
  public involvement in, and understanding of,
  local and national health service policy
  development

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Specific Targets (15) (over a 7 year period)

• reaching agreement with the professions on the
  security of electronic systems and networks
  carrying patient identifiable clinical
  information
• developing and implementing a first generation of
  person-based Electronic Health Records, providing
  the basis of lifelong core clinical information
  with electronic transfer of patient records
  between GPs

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Specific Targets

• implementing comprehensive integrated clinical
  systems to support the joint needs of GPs and the
  extended primary care team, either in GP
  practices or in wider consortia (e.g. Primary
  Care Groups)
• ensuring that all acute hospitals have the
  ability to undertake patient administration,
  including booking for planned admissions, with an
  integrated patient index linked to departmental
  systems, and capable of supporting clinical
  orders, results reporting, prescribing and
  multi-professional care pathways

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Specific Targets

• connecting all computerised GP practices to the
  NHSnet
• providing 24 hour emergency care access to
  relevant information from patient records
• using NHSnet for appointment booking, referrals,
  discharge information, radiology laboratory
  requests and results in all parts of the country

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Specific Targets

• the development and implementation of a clear
  policy on standards in areas such as information
  management, data structures and contents and
  telecommunications with the backing and
  participation of all key stakeholders
• electronic community prescribing with links to
  the Prescription Pricing Authority
• routine considering telecare and telemedicine
  options in all Health Improvement Programmes

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Specific Targets

• offering NHS Direct services to the whole
  population
• establishing local Health Informatics Services
  and producing costed local implementation
  strategies
• completion of essential national infrastructure
  including the networking infrastructure, national
  applications etc.

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Specific Targets

• opening a National Electronic Library of
  accredited clinical reference material on NHSnet
  accessible by all NHS organisations
• planning and delivering education and training in
  informatics for clinicians and managers

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The arguments for a move towards an electronic
record are compelling. Such records are more
likely to be legible, accurate, safe, secure, and
available when required, and they can be more
readily and rapidly retrieved and communicated.
They better integrate the latest information
about a patients care, for example from
different departmental clinical systems in a
hospital.

• section 2.7

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Electronic Patient Record

• The record about the periodic care provided
  mainly by one institution.
• Typically will relate to the healthcare provided
  to a patient by an acute hospital.
• EPRs may also be held by other healthcare
  providers, for example - specialist units or
  mental health NHS Trusts.
• Section 2.10

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Electronic Health Record

• Describes the concept of a longitudinal record of
  patients health and healthcare - from cradle to
  grave.
• It combines both the information about patient
  contacts with primary healthcare as well as
  subsets of information associated with the
  outcomes of periodic care held in the EPRs.

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• Over the lifetime of the strategy, the
  Government will support implementation of
  Information for Health with an investment in
  excess of one billion pounds.
• Section 7.9

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First Year (1999)

• 70 million pounds (175,000,000)
• 40m connect all computerized GP practices to
  NHSnet
• 10m additional IT expertise for local
  implementation
• 20m development of information services for
  primary care groups

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Timelines
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1998 to 2000

• Ensuring the NHS copes with the millennium (Year
  2000) problem
• Developing initial costed Local Implementation
  Strategies (agreeing them with Regional Offices)
• Completion of essential infrastructure
• Connecting all computerised GP practices to
  NHSnet

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1998 to 2000 (contd)

• 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

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2000 to 2002 (contd)

• 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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Theres More

• But theres no more time