QUALITY DATA: QUALITY CARE

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QUALITY DATA QUALITY CARE

• Michael Thick
• Chief Clinical Officer, NHS CFH

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Welcome

• My background.
• The role of Chief Clinical Officer of NHS CFH.
• Why am I keen to talk to you today?

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Agenda

• Programme achievements.
• The Office of the CCO.
• Where are we heading?
• What kind of benefits can we expect?
• What do we need to do?
• How can you get involved?

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Programme Overview 2002 The original scope in
2002
Provide Prescriptions Service
Provide Bookings Service
Build Life-long Health Record Service
Pervasive national electronic infrastructure (N3)
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Programme Overview 2007 Where we are
in early 2007
Payment by Results
100
100
Provide Prescriptions Service
Transfer of records between GPs
Provide Bookings Service
Build Life-long Health Record Service
Digital Imaging
Quality Management Analysis System
Bowel Cancer Screening
Secondary Uses Service
NHS Email System
50
NHS Numbers for Babies
50
Patient Choice
Progress
Progress
0
0
Daily usage
Daily usage
16,000 bookings
16,000 bookings
1m new images
1m new records
750,000 paid
2,500 babies registered
350 screenings
100,000 prescriptions
1.4m enquiries
1m messages
50 transfers
Pervasive national electronic infrastructure (N3)
Original Scope
Key
Additional Scope
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Myth busters

• The largely negative media has shaped public
  opinion by persistent criticism. An opposition
  campaign is being well orchestrated. The
  evidence by the 23 academic critics is almost
  wholly based on media coverage, hostile
  submissions to the Public Accounts Committee and
  Select Committee and Parliamentary Questions

The Programme is over budget - Not true. The
National Audit Office acknowledge there has been
no increase in the original costs of the core
contracts. No payment until delivery ensures no
wastage of public funds arising from delays The
Programme is subject to delays - Partially is
true. Much of the Programme is complete with
software delivered to time and budget. Some
deployment is progressing more slowly than we
would wish for and is dependent on legacy IT
suppliers and NHS preparedness. Delays have been
experienced in deployments of Patient
Administration Systems to acute hospitals and in
the clinical record. Conversely, many parts of
the programme, such as Picture Archiving and
Communications System, are early and were not
originally in scope The system is not secure -
Not true. The IT system is the only public
sector system to use e-GIF level 3 requiring a
Smartcard and PIN issued only on production of ID
(Passport) and address (utility bill). Role
based access is only for staff with a legitimate
relationship with the patient. Human factors
(sharing smartcards or passwords) attract legal
or disciplinary processes No clinical
engagement - Not true. There has been
substantial engagement. Thousands of named
clinicians helped to develop the original
specification and evaluate the suppliers proof
of solutions and bids. Teams of clinicians are
engaged daily, working with suppliers on
requirement, design, build and test activities.
No consensus on controversial issues. GPs views
are coloured by opposition to Choice policy and
lack of choice of own IT systems (being addressed
by GP Systems of Choice) The Programme will fail
if suppliers walk away - Not true. The
contracts were constructed with the expectation
that not all prime or subcontractors would last
the distance. Being able to replace IDX,
ComMedica, EDS and Accenture is testimony to the
commercial strategy. An Official Journal of the
EU (OJEU) advert is planned to refresh the
supplier capacity and capability. Accentures lax
cost control and project management resulted in
delay. Accenture absorbed their own cost overruns
of 700 million, not the tax payer. This was
novel and contentious Policy has changed since
the contracts were let - No surprise there.
Policy is bound to change during a ten year
programme. NPfIT has already incorporated
Quality Management Analysis System (QMAS) to
implement Quality Outcomes for GPs to deliver
patient benefits (Quality Management Analysis
System delivered on time in 2005) Payment by
Results worked every day to move money to Trusts
based on results (Payment by Results - delivered
on time in June 2005) and will include 18 weeks,
Practice Based Commissioning and NHS
re-structuring during 2007. The architecture is
designed to support new policy and new
technology Benefits are not being realised -
Not true. Quality Management Analysis System has
improved patient care. Picture Archiving and
Communication System has reduced diagnostic
waiting times. Electronic prescriptions have
improved accuracy in prescribing. Payment by
Results has incentivised performance. Choose and
Book has delivered patient choice and has reduced
Did Not Attends. The Patient Demographic
Service has reduced letters sent to the wrong
address. All have reduced costs and enabled
improved performance
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Programme expenditure to 31/12/06

• 8 core contracts (5 LSPS, N3, Spine, Choose and
  Book) 1b.
• (Planned 2.29b)
• 2) Additional requirements 0.6b.
• Planned total 2002 2012 6.2b
• (NAO estimate 10 -12b)

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Office of the Chief Clinical Officer
Agency board
NPfIT Board
Clinical Executive
Governance of clinicians and activity
Clinical Change
Clinical safety
Governance of clinical content
Information governance
Stakeholder management communications
Working Parties
National Advisory Groups
Cluster
Design Steering Groups
SHA
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Workstream level
The Office of the Chief Clinical Officer
Programme level
Sub-programme level
Project / service level
Clinical Content Service SRO Mark Davies PM tbc
Governance of Clinicians Activity
Information Governance
Clinical Safety
Stakeholder Management Comms
SNOMED Structured Electronic Records Programme
E-Care Pathways Service
Governance of Clinical Content Content SErvice

• Governance of Clinical Content Framework

• Paper based pathways
• e-pathway solution

Strategy Development
SNOMED Mandation, compliance Roadmap
DOAS
Requirements Service
Requirements Management CUI. SNOMED Subsets
Design Guidance Service
Migration Support Service
Early Adopter Project
Developing Sustaining Capabilities
SNOMED Networks. Training. Awareness Campaign
Authoring Service
Implementation Service
Terminology Help Desk
Delivery Unit Service Management
Delivery Unit Tech Office
UK National Centre
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SNOMED Structured Electronic Records Programme
Governance Structure Headcount
SSeRP Programme Board
SSeRP Steering Group
SSeRP Governance Groups
SSeRP headcount
DSP headcount
NHS/SHA headcount
CPP other headcount
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The Office of the Chief Clinical Officer
Portfolio of Services
Programme Name SNOMED in Structured electronic
Records Programme

• Programme Aims

Programme deliverables

• SNOMED-CT Subset Development Maintenance
  Process and Tools
• Subset Development Co-ordination and Management
• Development of Initial Subsets
• SNOMED CT Product Maintenance Process
• SNOMED Implementation Collaborative Forum
• SNOMED CT Early Adopters Supported
• Initial SNOMED CT Implementation Toolkit
• SNOMED CT Implementation Usability and Fit for
  Purpose Study
• Engagement, Promotion and Communications
• Education and Training
• SNOMED CT Implementation Roadmap

• Support a controlled implementation of SNOMED CT
  in electronic patient records (EPR) systems
  across the NHS.
• Support the development of the necessary
  capabilities (skills and knowledge) within the
  Service to encourage the acceptance and
  exploitation of the benefits of SNOMED CT based
  EPR systems
• Support the process change (clinical and
  otherwise) that the implementation of SNOMED CT
  based EPR systems will bring.
• Support the activities to ensure SNOMED CT
  implementations in EPR systems meet clinical
  safety requirements.

Contact Details
Leon Lau Email leon.lau_at_nhs.net Mobile [phone]
893
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The Office of the Chief Clinical Officer
Portfolio of Services
Project Name SNOMED CT Subset Development Project

• Project Aims

Project deliverables

• To support implementation of SNOMED CT by
• establishing processes for subset development
  and maintenance
• - ensuring priority subsets are identified and
  developed
• collaborating and communicating with Local
  Service Providers and suppliers to promote
  implementation of subsets
• To help clinical teams to meet governance
  standards and provide SNOMED CT expertise
• To advise on subset maintenance requirements
• To work collaboratively with Data Standards
  Products Terminology Services to help maintain
  SNOMED CT

• Criteria to select/prioritise the initial list of
  NHS SNOMED CT subsets established
• Subset development process and tools identified
  tested and rolled out
• Subset development resources recruited and
  trained
• Subset sign-off and approval criteria established
• Subset development managed and co-ordinated
• Subset development and maintenance training
  prepared
• Interim term addition/maintenance process
  established
• Process and governance for new term addition
• Process and governance for term retirement

Contact Details
Dr Richard Gain Email richard.gain_at_nhs.net Mobile
07733 310115
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The Office of the Chief Clinical Officer
Portfolio of Services
Project Name Support of Early Adopters in the
Implementation of SNOMED CT

• Project Aims

Project deliverables

• To support implementation of SNOMED CT by
• Understanding the experience of Early Adopter
  sites and communicating to relevant stakeholders
  Central, Cluster and Trusts
• Facilitate implementation process by supporting
  the resolution of SNOMED related risks and issues
• Translate that understanding into products that
  support future implementation activity
• Develop specific work packages of support to
  Early adopter sites

• Mechanism to record, resolve or escalate local
  implementation issues
• Capture lessons learned via agreed proforma
• Collate feedback and channel where necessary to
  Common User Interface Programme
• Safety and fit for purpose study at an early
  adopter site
• Implementation toolkit containing
• A case for SNOMED CT
• Readiness Assessment
• Implementation Guidelines

Contact Details
Colette OKane Email Colette.OKane_at_nhs.net Mobile
07891364741
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The Office of the Chief Clinical Officer
Portfolio of Services
Project Name SNOMED Education, Training and
Promotion Project

• Project Aims

Project deliverables

• Align with Data Standards Products (DSP) and
  Education Training and Development in relation to
  training activity
• Translate lessons learned from early adopter
  activity, guidance from cluster terminology leads
  
• and mature Electronic Patient Record (EPR) sites
  into training and education approaches
• Develop momentum and create engagement at
  cluster, trust and user level

• Stakeholder engagement and communications plan
• Set up and maintain a Cluster Implementation Sub
  Group aligned to the National Terminology Forum
• Attendance and support provided to the
  Terminology Forum
• Set up a collaborative website to support as a
  communications forum and share work
• Define and agree the scope of undergraduate and
  post graduate training in SNOMED CT
• Define and agree implementation requirements
• Define and agree SNOMED CT awareness, promotion
  and education materials
• Organise a National SNOMED CT Conference

Contact Details
Colette OKane Email Colette.OKane_at_nhs.net Mobile
07891364741
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Where are we heading? (1)

• The NHS Care Records Service (NCRS) will make
  relevant parts of a patients clinical record
  available electronically to relevant carers.
• Safe and routine exchange of care records
  nationally as well as at local health community
  level will bring substantial clinical safety and
  business benefits.
• All NHS CFH systems and services that support
  NCRS must be SNOMED CT compliant.

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Where are we heading? (2)

• In order to fulfil such a vision we need clinical
  terminology as an essential part of
  infrastructure.
• NHS will standardise on one clinical terminology
  to support care, commissioning and PbR.
• We lead the world and we are seeing support from
  professional groups, e.g. RCGP, RCP, Allied
  Health Professionals.
• We are part of an international community aiming
  to exploit SNOMED CT.
• We will take an incremental approach to
  implementation.

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What kind of benefits are we expecting?

• No ambiguity across care domains.
• Allow precise recording of clinical information.
• Ability to search records for clinical
  information.
• Identification of patients with a given set of
  criteria.
• Provision of decision support.
• Public health monitoring.
• Outcome analysis.
• Performance analysis .
• Commissioning.
• Payment by Results.

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What have we yet to do?

• Develop mechanisms to ensure consistent
  implementation of SNOMED CT based structured
  records.
• Accelerate the pace of implementing SNOMED CT
  based structured records.
• Ease the transition from legacy to SNOMED CT
  based structured records.
• Improve the acceptance of SNOMED-CT based
  structured records.
• Develop the necessary skills and competence to
  support the implementation of SNOMED CT based
  structured records.
• Establish leadership in the continual development
  of SNOMED CT and related standards to assure
  effective implementation.
• Align suppliers to meet the NHS needs in the
  implementation of SNOMED based structured
  records.
• Integrate SNOMED CT into HCC, CNST and NHS-LA
  standards.

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How can you get involved?

• You have taken the first step to come to the
  conference.
• Participate in SNOMED CT subset and/or other
  clinical content development.
• Participate in your local Terminology Groups.
• Keep yourself informed via our Health Informatics
  website. http//www.informatics.nhs.uk/groups/snom
  ed_ct/index.html
• Educate yourself in the basis of SNOMED CT.