The Go-Between Issue 80 February 2008 Information for Information Users

http://london.assist.org.uk/resources/resources.htm
The Go-Between
Information for Information Users
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 81 is 20 March 2008.
For contributions etc. please write to the Editor
(address on back page).
____________________________________________________
In This Issue
Capacity & Capability
Diary
Electronic Document
Management
Healthcare 100 - Integration in
London
Information Management 300
News in Brief
____________________________________________________
Healthcare 100 –
Integration in London
The model for the Care Records Service in London - also
known as the LHMS (London Healthcare Management
System) – is to have a set of systems with a Shared
Patient Record (SPR) or an “Integration Layer”. The
systems are different for each care setting:
•
Acute Healthcare: Cerner Millennium
•
Primary Care: InPractice / EMIS
•
Mental Health: RiO
•
Community Health : RiO
Issue 80 February 2008
•
•
Patient event record – a list of all of the clinical
events related to the patient that have occurred within
LHMS systems.
Summary view – a summary of the patient’s allergies
and medications, maintained by the patient’s GP.
The NHS Spine will provide a national Summary Care
Record (also known as PSIS) - a national summary of key
clinical events, allergies etc for each patient.
The London Programme for IT is working closely with PSIS
colleagues to ensure the SPR complements PSIS and
detailed care setting records. Care setting applications
(RiO, Millennium, etc) will be able to query the SPR for
information about a patient (query from acute only
supported from Healthcare 200 – the second release of the
Integration Layer).
Healthcare 100 will be designed so that information from
disparate sources will be presented to users, rather than
users having to separately query different sources. There
will be opportunities for users to influence the design of
Healthcare 200.
The SPR will store more historical information than PSIS
and will provide a view of the patient’s journey.
Notifications
Notifications in Healthcare 100 are messages generated by
the SPR. They will be sent to all clinicians using an LHMS
system who have an active relationship with a particular
patient. An active relationship is created at the start of a
particular encounter (e.g. referral) and lasts until the end of
the encounter (e.g. when the patient is discharged).
Notifications are triggered by clinical and administrative
events e.g. an assessment, and will appear in inboxes in
care setting applications. Access to the notification will be
subject to information governance rules.
Continued on page 2.
____________________________________________________
The first release of the Integration Layer is being branded
as Healthcare 100, the main functions are: the sharing of
key clinical information across care settings, building on
existing cross care setting business processes. Shared
information will include referrals, discharges, assessments
and results, and the sharing of clinical information within
care settings. These will be proactive notifications of
patient clinical events for the healthcare providers treating
that patient.
For mental health and community health the sharing of
clinical information will be from one RiO database to
another known as “RiO2RiO”.
For Acute Trusts
Powerchart Outreach will provide a read-only view of
patient information in other Millennium domains. All clinical
information sharing will be in line with national information
governance guidance.
The SPR (Shared Patient Record) consists of:
The NHS will not be able to ditch the paper by simply
implementing the Care Record Service – see page 2.
Continued from page 1.
Further information about the clinical history of the patient
can be obtained by querying the SPR. There will be a
facility for notifications to be “unsubscribed” – they will not
be received for the duration of that encounter by that
service until an explicit “re-subscribe”.
In principle the LHMS will support existing business
processes for cross care setting clinical communication.
Point to point clinical messages will be copied to the
Shared Patient Record (SPR), from where they are
available to all interested clinicians. Clinical messages
without a specific destination will be stored in the SPR.
Electronic Document
Management
This article summarises the main themes coming out of a
recent ASSIST
event on Electronic Document
Management (EDM).
Despite the advance of information technology most
organisations still consume vast amounts of paper. In the
NHS there are still paper medical records and cumbersome
corporate filing systems.
Referrals may still be sent using Choose and Book, where
this is used (alternatively a direct LHMS referral can be
sent). Referral letters will be stored in the SPR and
available to LHMS clinicians (subject to information
governance rules).
With the introduction of the Care Records Service (CRS)
systems the paper record will not disappear straight away,
even for current patients. The value of old data varies
between specialties, having dual systems – CRS and
paper – will be difficult to manage.
On discharge, a discharge message will be sent to the
referrer (and GP if it was not a GP referral) and a copy of
the discharge message will be stored in the SPR.
Assessments can be shared via the SPR.
The problems with paper systems are numerous:
•
Misfiling of documents
•
It is labour intensive to tidy and file documents
•
Some documents never get filed
•
Records get lost or misplaced
•
Multiple records exist (in error, because of temporary
files, separate departmental records)
•
The time taken to find relevant information
•
The need for paper management systems – policies
for retention disposal etc
•
Health and safety issues of carrying heavy files
•
Space taken to hold paper records
•
The effort of transporting records
•
Little or no auditing of who has accessed records
•
Records left in insecure places (e.g. back seat of cars!)
•
It is difficult to control access
•
Cost.
All messages will be structured, with free text and with
limited SNOMED coding.
Information Governance
Each care setting application will be required to implement
the information governance rules as agreed for Healthcare
100. This includes:
•
Single Sign On (SSO) with Role Based Access Control
(RBAC)
•
Checking of the NHS Spine for “Consent to share” flag
prior to allowing a user to access a patient’s clinical
record – access being denied if the patient has
dissented
•
Checking of the Spine Legitimate Relationships (LRs)
prior to allowing a user to access a patient’s clinical
record – access being denied in no valid LR exists
Sealed Envelopes are not within the scope of Healthcare
100 and will be a future development. These rules are
applied equally, whether accessing patient’s clinical
information held locally by the application or held within a
separate (RiO) instance or (Millennium) domain or stored
within an integrated service such as the national Summary
Care Record or SPR. If access is denied as a result of the
governance rules outlined above, the clinician has the
option of overriding patient’s dissent and/or self claiming an
legitimate relationship in order to access the information,
they are warned, must provide a reason and a Caldicott
Guardian alert is generated.
The information governance rules are likely to be
controversial and much debated.
Administrative
communications are handled in a similar way.
The next version of integration layer – Healthcare 200 – will
include:
•
an increased level of SNOMED coding in clinical
messages
•
enhanced support for integrated care pathways
•
support for prevention, screening and surveillance,
and
•
support for sealed envelopes.
More information
http://www.connectingforhealth.nhs.uk/london
____________________________________________________
The benefits of EDM (Electronic Document Management)
systems include:
•
Information is available when required
•
Information is available simultaneously in different
places
•
Electronic records are more complete, consistent,
structured
•
It is easier to conduct research
•
Support knowledge management
•
Supports decision support
The management of electronic documents can be just as
problematic without an EDM system. Documents are
saved in multiple locations with little or no version control
often in personal folders. Corporate e-mail is “locked”
away in personal e-mail accounts.
The strategic drivers for implementing an EDM system
support both clinical services and good governance, and
include improving the patient experience, improving safety,
rising costs of storing and transporting paper records, and
the modernisation of services. EDM should be seen as a
cornerstone for good knowledge management and good
information management.
Organisations are increasingly information-centric. In 1996
Shell estimated that staff spent up to 60% of their time
looking for information. By implementing EDM this has
been reduced to 38%.
Before embarking on EDM organisations need to address
their policies and strategy for records management and
scanning (of paper). Records management needs to be
fully integrated into business processes. There is an
international standard – ISO15489 – for records
management as a reference or standard for which to
aspire.
The implementation of EDM is not risk-free. Risks include
infrastructure, workforce issues (staff affected by giving up
the paper), acceptability of electronic systems, the impact
on working practices and security
To end with, some quoted statistics:
¾ The average document is copied 19 times and costs
£14 to file.
¾ An average four-drawer filing cabinet costs £17k to fill
and £15k per annum to manage
¾ Only 35% of electronic corporate documents are
accessible
¾ 45% of printed documents are thrown away within a
day.
¾ 60% of documents produced as evidence in US courts
are e-mails
More Information:
A Google search
on
“Electronic Document
Management provides many case studies on EDM.
_______________________________________________
Capacity & Capability
Developing and improving capability and capacity to deliver
IT-enabled change across the NHS is one of the top
priorities for the NHS Chief Executive, and the subject of a
project being driven by Connecting for Health (CfH).
The initial project started in February 2007 and concluded
early November 2007. Strategic health authorities (SHAs)
and primary care trusts (PCTs) have now assumed clear
accountability for National Programme for IT (NPfIT)
implementation and benefits realisation.
The overarching objective of the capability and capacity
(C&C) project was to ensure that the NHS chief executive
and NHS management board had evidence-based
assurance that NHS organisations had the appropriate
capability and capacity to deliver their new NPfIT
responsibilities and accountabilities across the entire
implementation lifecycle, and to deliver against the current
implementation plan.
The focus of the project was to establish and embed
sustainable work programmes that support the on-going
and long term needs of the NHS.
What is meant by Capability?
Organisational capability is the ability to undertake a
defined activity in a professional and effective manner. In
the short term, this means the NHS will have the collective
capability to manage NPfIT and in the longer term, to
deliver effective informatics across organisations.
What is meant by capacity?
Capacity is having the ability to secure sufficient numbers
of people with the right skills over a time period to execute
the activities as required. This means the NHS having the
required resources to deliver the detailed implementation
plan produced with the local service providers.
To help guide the development and adoption of project
outputs, an NHS reference panel was established, made
up of front-line and subject-matter experts from across the
NHS.
LISA - the Local Health Community IM&T Self Assessment
tool was launched in February 2008, to support PCTs in
delivering their accountability for IM&T-enabled change
across their Local Health Community.
A series of consultation events in November and
December 2007, organised by ASSIST were used to share
findings, take counsel on proposals and share
understanding and joint ownership of the action plan going
forward. Detailed plans will follow the consultation events
and are soon to be released.
Current work includes HIS (Health Informatics Service)
benchmarking; developing the eSpace collaboration tool
and facilitation of PCTs in their community wide IM&T
planning exercises.
Capability and Capacity fact sheets
The project has produced a series of fact sheets which
include:
•
Executive
Leadership of
IT-Enabled
Service
Transformation
•
Assurance for organisational readiness
•
Health Informatics Services
•
Evidence Based Implementation Support
•
eSpace
•
Programme and Project Management Improvement
•
Health Informatics Competency Assessment Initiative
•
Capability and Capacity - Further information and
resources
More information:
http://www.connectingforhealth.nhs.uk/systemsandser
vices/capability/
LISA:
http://www.connectingforhealth.nhs.uk/systemsandser
vices/capability/lisa
_______________________________________________
Information
Management 300
The London Programme for IT as part of the Care Records
Service (CRS) is proposing to provide a data warehouse
being branded as Information Management 300 or IM300.
The Information Management (IM) subsystem would
provide a central data warehouse and reporting capability
across all trusts in London that have deployed. The
objective is to meet specific reporting needs of London
trusts.
The IM300 release of the IM subsystem aligns with that of
Healthcare 100 – see article above.
IM300 would receive data feeds from each of the three
care settings’ applications instances – RiO (community and
mental health), Cerner Millennium (acute) and InPractice /
EMIS (primary care). This data is then integrated to
support cross-care setting reporting and data extract
capabilities via Business Objects
The majority of data would be available within the IM
Subsystem within 24 hours of being written to the care
setting applications. Specific data relating to bed-states
across care settings would be available in a dedicated IM
repository fed in near real time from the care setting
applications.
It is understood that the information governance issues of
IM300 need to be addressed. It is not yet clear how
Foundation Trusts are able to restrict access to their data
thereby protecting commercially sensitive information, or
even whether they can opt out of the system.
More information:
http://www.connectingforhealth.nhs.uk/london
_______________________________________________
News in Brief
IM&T Spending Levels
NHS Connecting for Health have recently issued a
summary report from the NHS Investment Survey (2007).
It shows that the average percentage spend on IM&T in
NHS organisations has increased from 1.64% in 2002/03 to
1.76% in 2006/07. If central spend is include the figures
are 2.0% (2002/03) and 2.7% (2006/07).
NPfIT Papers to Be Released
The briefing papers which led to the creation of the
National Programme for Information Technology (NPfIT)
are due to be released under a Freedom of Information
request, following a 3 year campaign by Computer Weekly.
Information Sharing Consultation
Richard Thomas, Information Commissioner, and Dr Mark
Walport (Wellcome Trust), are conducting an independent
review in to the sharing of personal information in the
public and private sectors. Issues to be considered include
how to balance the protection of individual privacy against
the business efficiencies and service improvements which
can be gained from personal information sharing, in the
light of a background of ever greater technological
advances. Also to be reviewed is whether there should be
changes to how the the Data Protection Act 1988 operates.
See: www.justice.gov.uk/publications/data-sharing-reviewconsultation.htm.
Social Care & NHS Spine
Four sites have been selected pilot links between their
social care systems and the NHS Personal Demographics
Service (PDS) of the NHS Spine, enabling social services
to access their client's NHS numbers when sharing
information with the NHS. The four early adopters –
Cheshire County Council, London Borough of Greenwich,
Slough Borough Council, and Torbay Care Trust. – will
need to demonstrate compliance with the information
governance requirements for the NHS Care Records
Service, as set out in the NHS Care Record Guarantee.
Learning Management System
NHS Connecting for Health (CfH), in collaboration with the
Department of Health, is supporting the deployment of a
new NHS National Learning Management System, linked
to the Electronic Staff Record. This new national Learning
Management System (NLMS) will offer huge benefits to
those NHS organisations seeking to offer education and
training online. The new arrangements will enable CfH to
support the deployment and upgrade of National
Programme applications and services to the NHS by
offering e-learning resources in a timely way to end-users,
managers and others across the NHS. Linking the NLMS
to the Electronic Staff Record (ESR) will make it possible
for anyone with an ESR profile to access e-learning
resources and programmes that are offered at a national
level. Successful completion of these programmes will be
recorded on the individual learning records of NHS staff.
See: http://www.esrsolution.co.uk/.
PACS Rollout Complete
The Department of Health has announced that all hospital
trusts are now using PACS, the technology which allows xrays and scanned images to be stored electronically and
viewed simultaneously at multiple locations. The roll-out of
PACS has been a major element in the National
Programme for IT. The PACS programme will now focus
on further technical developments such as improved
sharing of images between trusts.
IT Service Desk Accreditation
On 21 January South West London & St George’s Mental
Health Trust became the latest organisation (and first
Mental Health Trust) to have a nationally accredited IT
Service Desk. Others include Barts & the London, Kent &
Medway HIS, Surrey HIS and North & Mid Hants HIS. See
nww.connectingforhealth.nhs.uk/servicemanagement/accre
ditation, for information on accreditation.
___________________________________________________
Diary
26 Feb 08
Electronic Staff Record
(www.bcs.org/staging/server.php?show=nav.9418)
The implementation of the Electronic Staff Record (ESR)
project is reported to be on track to complete by the end of
March 2008.
11 Mar 08
Local IM&T Plans
09 Apr 08
The NHS Operating Framework for 2008/09 identifies the
need for sustained focus on information management and
technology (IM&T) in the NHS to deliver better, safer care.
The objectives for 2008/09 are that:
•
Individual organisations will work collaboratively within
community-wide governance arrangements to produce
an inclusive IM&T plan that effectively supports the
delivery of high quality services for patients and
provides front-line staff with the tools and information
they need to provide these services;
•
Local IM&T plans will meet national expectations and
will make available the funding and capacity, including
clinical time, to do so;
•
IM&T planning will be further integrated with
mainstream NHS service planning, building on the
progress made in 2007/08.
Local IM&T plans should be complete and quality assured
by PCTs and SHAs by 31 March 2008.
BCS Kingston & Croydon: “Managing
Complex Projects”, West Croydon
Electronic Records for Health Research
London WC1
(http://etdevents.connectingforhealth.nhs.uk/all/1541)
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