The Go-Between Seasons Greetings! Issue 79 December 2007

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The Go-Between
Information for Information Users
Seasons Greetings!
Issue 79 December 2007
It is hoped that eSpace will bring improved information
sharing, enhanced communications and continuing to build
on the networks and communities that already exist.
At the heart of eSpace is a group of communities dedicated
to bringing about positive change in healthcare.
The Go-Between wishes its readers a happy Christmas
and a prosperous 2008!
The Go-Between would like to hear from potential
contributors. Articles should be on IM&T related matters
and around 250-400 words in length. Copy deadline for
Issue 80 is 20 January 2008.
For contributions etc. please write to the Editor
(address on back page).
____________________________________________________
In This Issue
Diary
GP Systems of Choice
New Ways of Working
News in Brief
Snomed Clinical Terms
Summary Care Record Patient
Options
What is eSpace?
____________________________________________________
What is eSpace?
eSpace is an online collaboration tool specifically designed
for the NHS that uses the power of the web to make it
easier for NHS professionals to work together whenever
and wherever they need to.
eSpace is an online service provided by NHS Connecting
for Health (CfH) that offers collaboration functionality to
those with an interest in IT-enabled change and peer
collaboration in healthcare, for the NHS to use locally.
Once signed up the online communities members can start
to:
•
Collaborate much more easily with colleagues,
partners and others whenever and wherever you need
to – in the office, on the road or even around the world
•
Share experiences and liaise with groups of peers
facing similar issues and challenges
•
Keep on top of the latest themes, issues and
developments relevant to the individual member
•
Organise and manage schedules, share documents
and host meetings – all right from the desktop
•
Learn about new ways of working
•
Participate in discussions
•
Network with your colleagues across the NHS
•
Post and find answers to your questions
More information:
http://www.espace.connectingforhealth.nhs.uk//
____________________________________________________
Summary Care Record
Patient Options
Summary Care Records are being implemented as part of
the National Programme for IT in the NHS. Early adopter
sites are up and running (as reported in The Go-Between
Issue 78).
Whilst Summary Care Records offer many potential
benefits to the delivery of patient care there have been
some anxieties expressed about the system particularly in
the national press. It is likely that some patients will have
concerns about their Summary Care Record.
Some guidance material has been produced by NHS
Connecting for Health (CfH) to provide key facts that will
help answer patients’ questions. These guidelines will be
monitored during the Early Adopter Programme and
modified as appropriate.
Initially a Summary Care Record will contain information on
allergies, adverse reactions and current medications
extracted from the patient’s GP record. Over time it will
become a richer record as more information is added from
the GP record and later from the records held by
secondary care services where the patient receives
treatment.
Patients can request that the information in their Summary
Care Record is not made available and can only be viewed
by themselves through Healthspace. Patients can request
not to have a Summary Care Record at all.
Continued on page 2.
Continued from page 1.
If patients are concerned about who can see their
Summary Care Record, the advice is that the most
appropriate option is to choose the “dissent to sharing”
position. This means that although the information in the
Summary Care Record is not normally available, on the
request of the patient it could be readily made available to
clinicians who are treating them. Patients can make this
choice at any time and will be able to view their “consent to
sharing” status through Healthspace as it becomes
available.
The rollout of Summary Care records will be supported by
a public information programme. A leaflet will be given to
everyone aged 16 and over which explains the purpose of
a Summary Care Record, how to obtain a copy of the Care
Record Guarantee, and their options:
1.
2.
3.
To have a Summary Care Record, in which case they
need do nothing more. In doing this the patient is only
agreeing to the initial upload of allergies, adverse
reactions and medications from their GP record. The
addition of diagnoses from their GP record will occur
with the patient’s consent thereafter at an appropriate
consultation with their GP.
Not to have a Summary Care Record created, in which
case they must complete a form and should discuss
the matter with any member of the clinical team who is
available at their GP practice to ensure that they
understand the implications of their decision. This
discussion should also clarify that the NHS will
continue to endeavour to provide people who do not
have a Summary Care Record with the best services,
and will not discriminate against those who do not
choose to have a Summary Care Record.
To allow the process for creating the Summary Care
Record to be initiated and to look at the content by, for
example, obtaining a print out from their GP practice.
(Other means for patients to look at the content are
being explored during the early adopter sites). Once
the Summary Care Record process has been initiated
people have a minimum of a further eight weeks to
decide to either:
•
Have a Summary Care Record which is
accessible to those who are providing them with
care or treatment.
•
Have a Summary Care Record but not allow
anyone to see the information outside the
organisation which created it i.e. set their flag on
PDS to “dissent to sharing”.
•
Not have a Summary Care Record and follow the
process described above to achieve this.
Following this a blank record will be uploaded
which contains no clinical information and solely
indicates that the patient has chosen not to have a
Summary Care Record.
If a patient does not express their wishes within the 8
weeks after the Summary Care Record process is initiated
then their Summary Care Record will become accessible to
clinicians providing them with care or treatment.
Patients can change their decision at any time. However,
once a Summary Care Record has been created and has
been relied upon by those who provide an individual with
care, there are important medico-legal reasons which
require the information contained within the record to be
preserved.
The Department of Health is currently consulting on the
circumstances and required processes for managing
requests for amendment and/or deletion of information held
within health records.
Keeping good records when the Summary Care Record is
discussed with a patient is clearly important. Where a
patient was known to be either absent during the period
leading to the creation of their Summary Care Record, or
was considered to lack capacity under the Mental Capacity
Act 2005 during this period, it is recommended that the
decision is revisited with the patient, or anyone holding a
Lasting Power of Attorney under the Mental Capacity Act
2005 for the patient, at the next appropriate consultation.
Where a child is competent, the decision to request not to
have a Summary Care Record rests with the child, not the
parent as the request is made under the Data Protection
Act which looks to competence rather than age. Where a
child is not competent, the decision rests with the parent.
More Information:
http://www.nhscarerecords.nhs.uk/
_______________________________________________
GP Systems of Choice
The GP Systems of Choice initiative (GP SOC) was
introduced to ensure the effective delivery of the National
Programme for IT (NPfIT) functionality to the 90%+ of
practices that are not using an LSP solution, to meet the
commitment to provide practices with a choice of system,
and to get better value for money for the NHS.
Funding was made available to Primary Care Trusts
(PCTs) in July 2007 to enable the IT infrastructure within
general practices to be upgraded to a minimum
specification.
Infrastructure upgrades have to be
completed by 31 December 2007 to qualify for central
funding.
Following a procurement exercise eight suppliers were
selected and framework agreements have now been
signed, including INPS and EMIS who have, collectively,
over 90% of the primary care market in London.
PCTs are now in a position to start to transfer annual
licence agreements to NHS Connecting for Health (CfH)
and accrue revenue savings.
Through GP SOC the cost of the annual licence
agreements for GP clinical systems will be funded by CfH
centrally. There are a few caveats, e.g. GP systems must
be Level 2 compliant. The Step-by-Step guide can be
downloaded from the GP SOC website (see end of article).
There will need to be a Service Level Agreement (SLA) to
be in place between the practice and the PCT. The SLA is
being developed by the GP SOC programme and will be
available shortly. PCTs have been encouraged to sign
practices up to GP SOC and agree the SLA retrospectively.
PCTs will be required to pay the annual service
management fee of £650 per practice (irrespective of
supplier) plus any “add-on” functionality not covered by the
core NHS CFH/supplier contracts.
To encourage practices to sign up to GP SOC the PCT
may wish to consider how the savings might be used, e.g.
a proportion could be set aside to fund one or two days
training per annum, the purchase of a scanner, etc.
Data migration costs will be met by CfH when moving to an
LSP product but if moving to another system then costs will
continue to be met by the PCT.
PCTs will be required to continue to pay for training,
ongoing infrastructure upgrades, and a reduced system
support charge (£650/practice/annum). Typically, though,
a PCT should be able to make savings of between £4,000
and £6,000 (less the support charge and the cost of any
additional products per practice per annum).
More information:
www.connectingforhealth.nhs.uk/gpsoc
Contact: [email protected]
_______________________________________________
SNOMED Clinical
Terms
SNOMED CT (Systematised Nomenclature of Medicine –
Clinical Terms) is the healthcare industry standard of
clinical terminology, a vocabulary which aims to represent
the words and phrases used in healthcare in a consistent
way in association with unique codes. The codes are in
the background, not used or known by clinicians, and only
used by computers to store and communicate data.
The vision is that all computer systems within the NHS will
operate using SNOMED-CT increasing the quantity and
quality of information that is coded for analysis,
communication and information sharing. It helps organise
medical language into a structured framework. It will be
used to create electronic patient records and record clinical
information along side textual clinical notes.
SNOMED-CT will enable:
•
the efficient searching of patient records;
•
retrieval of relevant clinical information;
•
clinical decision support systems at the point of care;
•
links to knowledge sources;
•
automatic identification of risk factors, e.g. allergies;
•
the Summary Record that is fed by different systems
(i.e. using SNOMED-CT as a common language);
•
clinical messaging (referrals, discharge summaries
etc);
•
monitoring adverse reactions to treatments; and
•
analysis to support clinical research.
SNOMED-CT is a collection of about 400,000 medical
concepts, associated with about 800,000 description terms
for these concepts, and related to each other by a
hierarchy (also known as a “taxonomy”) consisting of about
12,000 relationships.
Concepts include presenting
symptoms, treatments, procedures, diagnoses and drugs.
Clinical terms are organised into subsets. The main
reasons for the subsets are to restrict or organise the terms
according to the intended use, to help the capture or
organisation of electronic records. For example in the
radiology part of an electronic care record the radiology
subset will be used; or a function that highlights drug
contraindications only the relevant terms will be available.
Generally clinicians will select SNOMED clinical terms by
typing in the first few letters of the desired term and then by
selecting the term of choice. Clinicians will not be required
to use or look up codes. As systems become more
sophisticated clinical terms may be captured in other ways,
for example, the result of a clinical assessment captured as
a series of check boxes may appear as SNOMED-CT term.
Effective communication requires a common language or
common understanding.
SNOMED-CT will facilitate
communication from one clinical system to another.
Instead of sending pieces of text to describe a treatment,
diagnosis or symptom codes will be used instead
(SNOMED-CT codes). As each code is linked to all
appropriate synonyms the recipient will be able to interpret
any message sent from another clinical system. This is
why SNOMED-CT is sometimes known as the “language of
Health”.
It is not difficult to see why SNOMED-CT is seen as
essential to delivering the vision of the National
Programme for IT.
There are several challenges to the widespread adoption of
SNOMED-CT.
Firstly systems need to be made
“SNOMED-compliant”, that is they have to be adapted to
accept the codes in the relevant parts of the system.
Whilst this is in the plans for the National Programme it will
take a few years for all systems to be fully compliant.
The experience of using SNOMED-CT is mainly confined to
primary care: secondary care has yet to fully embrace it.
Demonstration of the benefits by early adopters will help to
popularise SNOMED-CT.
The use of SNOMED-CT in capturing clinical information is
going to require a change in culture by the clinicians using
it. Again, evidence of the benefits will help to make the
necessary changes in working practices.
More information:
http://www.connectingforhealth.nhs.uk/systemsandser
vices/data/snomed
_______________________________________________
New Ways of Working
A new initiative in mental health services is New Ways of
Working (NWW). It is essentially about a new way of
thinking which includes the development of new, enhanced
and changed roles for mental health staff, and the
redesigning of systems and processes to support staff to
deliver effective, person-centred care in a way that is
personally, financially and organisationally sustainable.
The Department of Health has produced a best practice
implementation guide “New Ways of Working for
Everyone”. The guide sets out a comparison of a mental
health team from a traditional practice perspective (team A)
with a modern capability / competence-based team over a
number of different parameters (team B).
The intelligent use of information is an aspect of NWW and
illustrated in the Guide as follows
Team A
The team gets on with the job of providing a service but it
feels burdened by what seems to be ever-increasing
demand. There rarely seem to be any discharges, and
caseload mix is poorly monitored and regulated. There are
tensions as some team members feel they are working
harder than others, and the team manager has a difficult
job to try to keep things running smoothly.
Team B
The team has a transparent and open caseload
management system in place. There is regular supervision
and discussion at team level as well as audit to ensure that
there is effective balancing of caseloads based on
competence and frequent challenge to members to
consider what progress is occurring. The consultant
psychiatrist is challenged over their case mix, as is the
psychologist and social worker, because this is seen as an
exercise that encourages the intelligent use of information.
The team feels it knows what it is doing.
The Guide also includes an indicator in respect of IT:
“Information technology (IT) is available to support flexible
working – computers, Blackberries, laptops, video or
telephone conferencing, mobile telephones”
More information:
http://www.dh.gov.uk/en/Publicationsandstatistics/publ
ications/publicationspolicyandguidance/DH_4122342
_______________________________________________
Microsoft NHS Summit
News in Brief
Foundation Degree in Health Info
A new foundation degree in Health Informatics has just
been validated and will begin in January 2008. The course
will enable employees, already working within the NHS, to
gain the experience and knowledge of informatics for
personal development. The course is provided by three
institutions: Kingston University; St George’s Medical
School, University of London; and Royal Holloway,
University of London. Through a combination of distance
and on-site learning it will be possible to complete the
degree while still remaining in employment within the NHS.
See: http://www.kingston.ac.uk/healthinformatics.
Kent & Medway HIS
Congratulations to the Kent & Medway Health Informatics
Service (KMHIS) which has won the Transformational
Service Award in Touchpaper’s annual global customer
awards. This award recognises an improvement in the
service delivered by the KMHIS service desk over the last
12 months.
Placements for HI Students
A new industrial placement scheme for BSc / MSci
Biomedical Informatics students is now in place.
St
George’s University of London is offering 3-month or year
long placements. Contact: Placements Director Dr Derek
Meyer, at [email protected], Tel 0208 8725 0761.
Guidelines on Transporting Data
Good Practice Guidelines for the transfer of batched
person identifiable data by means of portable electronic
media has been provided by the NHS National Information
Governance team. For a copy of the Guidelines see:
http://www.igt.connectingforhealth.nhs.uk/GPG%20for%20t
he%20transfer%20of%20batched%20patientidentifiable%20data.doc
Quality Awards
Congratulations to the IM&T Department of SW London &
St George’s Mental Health Trust which received three
awards at the Trust Annual Quality Awards: Team
Efficiency Award (IT Service Desk); Implementation Award
(IM&T RiO Project Team); and Team of the Year (IM&T
Department).
Service Management in London
The London Programme for IT (LPfIT) have set up a new
website to provide information on service management
issues – processes and procedures, documents and
reference material – that may assist trusts in the local
management of NPfIT services (national applications). It
includes information on applications, service level
management,
incident
management,
problem
management, change management, release management,
escalation procedures, FAQs and general guidance. See:
http://nww.connectingforhealth.nhs.uk/itprogrammes/londo
n/service_management.
Microsoft is holding a summit on 15 January 2008 to
provide NHS Trust IM&T leaders with insights into current
thinking from: Matthew Swindells, Director General for
Information and Policy Integration (Department of Health);
Dr. Mark Ferrar, Director for NHS Infrastructure, (NHS
CfH), Gus Hartley, Infrastructure Lead (North West SHA),
and Microsoft and their partners. For information and
booking form see: http://msevents.microsoft.com/CUI/
EventDetail.aspx?EventID=1032361534&Culture=en-GB.
Tel: 0870 166 6680 ref 1534.
PACS Award
The Picture Archiving & Communications System (PACS)
programme – part of the NHS's National Programme for IT
– was awarded the title of Public Sector Project of the Year
in Computing magazine's Awards of Excellence. The
programme was recognised for its success in having
"delivered major improvements in public services, or new
ways of working, that have enabled greater efficiency or
cost-effectiveness". PACS enable images such as x-rays
and scans to be stored electronically. In less than three
years, the PACS programme has rolled out these systems
to 120 NHS trusts across England.
___________________________________________________
Diary
15 Jan 08
Microsoft NHS Summit, Reading
(see “News in Brief” item)
22 Jan 08
BCS Health Informatics Forum,
London WC2
([email protected])
23 Jan 08
National Education, Training &
Development Conference, Nottingham
([email protected])
07 Feb 08
BCS:“NPfIT – Lessons Learned”
London WC2
([email protected])
09 Apr 08
BCS “Sharing Clinical Documents and
Integrating Workflow”, Oxford
([email protected])
21 – 24
Apr 08
Healthcare Computing HC2008: “An
Invitation to the Future”, Harrogate
(www.bcs.org/server.php?show=nav.9333))
___________________________________________________________
Address for correspondence:
The Go-Between,
c/o David Green, Head of IM&T,
SW London & St George’s Mental
Health NHS Trust, Springfield
University Hospital, Tooting,
LONDON SW17 7DJ
020 8772 5602
[email protected]
London & South East