A game of two halves… …and two personalities

ASSIST NW
30 Oct 2008
A game of two halves…
…and two personalities
1. Health Informatics Review
Brian Derry, NHS CFH
ASSIST
Association for Informatics
Professionals in Health
and Social Care
2. The Independent Review of
NHS IT
Brian Derry, ASSIST Chair
The Health Informatics Review from words to deeds
ASSIST North West
30 October 2008
Brian Derry
[email protected]
Summary
• Background to the Health Informatics Review
• Health Informatics Review:
Strategy
Commitments
• Next steps and conclusions
Background to HIR
• Commissioned by NHS Chief Executive & DH Permanent
Secretary in September 2007
• Over 1,400 stakeholders consulted:
 1,000+ frontline NHS staff
 public opinion researched, through a deliberative event,
online questionnaire and survey
 voluntary organisations and professional bodies
 SHA & NHS Chief Executive Officers and Chief
Information Officers
• Findings published as part of NHS Next Stage Review, on 10
July 2008
HIR scope
Health Informatics Review Programme
Project 1
Meeting the
information needs
of the
DH and NHS
“Information”
Project 2
Project 3
Maximising the
benefits from
NHS CRS & SUS
Creating an
information system
and management
structure
“NHS CRS and
SUS”
“Governance”
To outline an information and IT architecture capable of supporting
the world-class NHS envisaged in the NHS Next Stage Review
NHS Next Stage Review
High quality care for all:
NHS Next Stage Review
Raising standards
Help to stay healthy
Empowering patients
Quality at the
heart of the NHS
Most effective
treatments for all
Stronger involvement of clinicians in
decision making at every level of
the NHS
Fostering a pioneering NHS
Keeping patients as
safe as possible
High quality care for
all
High quality
care for patients
and the public
Freedom to
focus on quality
Empowering frontline
staff to lead change
that improves
quality for patients
Valuing the work of
NHS staff
Need for high quality
information
•
People want information to:
 understand choices about care, & how to stay healthy
 be confident that health & social care staff have the information
needed to provide care effectively and safely
•
Care professionals: when providing care, regardless of where the
person was previously seen
•
Commissioners: plan & redesign services
•
Managers of health & social care services:
 monitor & assure quality
 make decisions based on evidence & best practice
 account for their actions
•
Regulators: to assure NHS & independent sector care providers
HIR strategic implications
HIR key themes
• Delivering better, safer care: person-based information for clinical &
care processes, shared across organisational boundaries
• Empowering staff to improve NHS performance: research,
planning & management, improving quality of care & supporting
regulatory activities
• Empowering patients and the public:
- making information available about health, services, & patients’
own health & wellbeing
- providing patients with secure access to their own electronic
records & increasing their involvement in shaping the NHS
• Focusing on IT alone will not meet the needs of the NHS.
Strategic consequences
•
Patient information available at the point of need
•
Strategic solutions making patient/client information available
securely across care settings
•
People will be able to:
 access their own care record securely
 have information to make informed choices about their own
healthcare and wellbeing
•
Additional services available to patients on-line
•
Information should:
 be collected once, as a by-product of care
 be used many times - new data only when absolutely necessary
 be improved through an integrated data quality programme.
Responding to clinical priorities
Achieving the strategic vision:
• Investigate interim solutions, including widening choice of LSP
solutions
• Trusts’ roadmaps by April 2009 describing how strategic vision will be
achieved
• Local solutions subject to convergence with LSP & national strategic
direction, & to local funding & business cases
Early delivery of priority secondary care products (“clinical five”):
• Patient Administration System (PAS) integrated with other systems &
with sophisticated reporting
• Order Communications and Diagnostics Reporting - all pathology &
radiology tests and tests ordered in primary care
• Letters with coding: discharge summaries, clinic and A&E letters
• Scheduling: beds, tests, theatres
• e-Prescribing, including ‘To Take Out’ (TTO) medicines
Fill information gaps:
• clinical metrics
• mental health; community and social care.
HIR commitments
1.
2.
3.
4.
Information and Standards
Systems and Benefits
People and Skills
Processes and Structures
Strand 1:
Information & Standards
Information actions
• Filling gaps: clinical metrics, community,
mental health, social care
• Data quality
• Access and use:
Syndication & Signposting
Strategic reporting solution
• Streamlining data collections
Information Standards
•
Fundamental review of the (1970s) NHS data model to create
one suitable for a 21st century NHS
•
Short- term improvements
 to meet immediate needs - community, mental health,
private sector care & measures of clinical quality
 reduce unnecessary bureaucracy
•
Scope of the NHS Care Records Service to cover independent &
voluntary sector providers, & social care
•
Technology & standards to allow high quality local products to be
integrated within hospitals; full integration of products across care
settings & providers
•
Robust process to ensure widespread adoption of existing
standards (e.g. NHS number, SNOMED)
Information Standards
Programme -7 elements
1. Logical Health Record Architecture


logical structure for an Electronic Health Record
definitions for key clinical concepts & associated coding
2. Commissioning Data Sets Futures – community, children &
maternity, long term conditions
3. Streamlining the end-to-end standards process
4. Social Care
5. Pathways Groups – maternity, long term conditions…
6. Metrics for measuring Care Outcomes
7. Analysis and Currencies – outputs & units of care activity
Strand 2:
Systems and Benefits
Systems to support high quality care
NHS Care Records Service –
Summary & detailed records
Choose and Book
PACS
Electronic Prescription
Service
Empowering
patients and
the public
High quality
care for
patients and
the public
NHS Choices
HealthSpace
Delivering
better, safer
care
Quality at the
heart of the
NHS
N3
Spine
NHSMail
Empowering
staff to
improve NHS
performance
Freedom to
focus on
quality
Secondary Uses Service
Clinical Dashboards
NHS Comparators
Staff Gateway
Research Capability Programme
GP Extraction Service
Clinical dashboards
Clinical team,
‘day-to-day
efficiency’
dashboard
Locally defined
dashboards: improve patient
flow & treatment patterns;
multi-disciplinary.
Rapid updates (up to every
15 mins)
Monthly
‘quality of care
benchmarking’
dashboard
Allows clinicians to monitor and
benchmark process
effectiveness & outcomes
against best practice. Focus on
qualitative outcomes, e.g.
patient experience, quality of
care.
Weekly/monthly updates.
Individual,
‘comparative
clinician’
dashboard
Allows clinicians to
monitor individual
metrics, compared with
peers. ’Portfolio’
contributes to continued
accreditation with
professional bodies.
Weekly/monthly
updates.
• Indicators align to national/international best practice & be integrated
with national clinical protocols (e.g. designed by Royal Colleges)
Staff Gateway
• Support NHS staff in delivering first class quality of care through
education & training, & access to knowledge & information
• NHS staff now have to access many different internal information
& IT systems to do their jobs
• Staff Gateway to provide:
 ‘one-stop-shop’ for the key information sources
 Professional portfolio:
 single access point to development and knowledge
 a space for storing information essential to appraisal,
revalidation & clinical excellence awards
 online log of personal activity & outcomes
HealthSpace
• Empower patients & public
• Already lets patients record information on their own
health; also:
record preferences
record self-administered drugs & health
monitoring
let patients see their own Summary Care Record
NHS Choices
• Much more information, not just hospital care
but also primary & community care
• To be the reliable source of information to
help patients understand their illnesses &
stay healthy
• In time, will include:
 other services such as those provided by
social care will be included.
 new local and national clinical metrics and
dashboards
Strand 3:
People & Skills
Informatics-literate NHS
Informatics-literate NHS
Strong informatics governance
Sound
leadership
Within
DH &
NHS
Outside
DH &
NHS
Skilled staff
Good
processes
Standards
governance
Policy
integration
Investment
assessment
Informatics
staff
Other staff
Sound leadership
• New CIO for Health – Christine Connelly - Board level post reporting
directly to the NHS CEO
• CIO has formal responsibility for providing professional leadership to the
major informatics organisations inside and outside the Department of
Health
• Expectation that SHA, trust and PCT boards include a “credible, capable
CIO able to contribute fully to strategic leadership and Board decisions”
• National informatics leadership to:
 develop the profession
 co-ordinate the existing expertise
 build the informatics capability of the general and management
workforce
Good processes
•
Improved arrangements for early assessment of the
central and local informatics implications of new
policy – “Policy and Business Informatics Support”
•
Ensure that IM&T priority and funding is given to the
most appropriate requirements
•
Mainstream IM&T planning - NHS Operating
Framework, IM&T planning guidance
Skilled staff
• Creation of a health informatics career framework, mapping to the
wider NHS career framework, to guide development of staff who wish
to progress
• Health Service leadership to address skills needed in the NHS to
deliver large scale IT-enabled change & to develop the Informatics
Profession.
• Informatics content - to agreed national standards - in core training &
professional development programmes for NHS clinicians and
managers
• SHAs and NHS CFH to work with suppliers on supplier capability to
help ensure that planned milestones are met & products are fit for
purpose.
Developing the
informatics workforce
Career
pathways and
development
Workforce
development
and planning
• Embed health informatics into NHS Careers Framework
• Clearly define standardised pathways & criteria for
advancement
• Provide skills & training modules linked to each career level
• Create options for different paths to support different
individual skills & aspirations
• Encourage the development of a skilled talent pool with
relevant qualifications, through partnership with educational
institutions
• Strengthen long term planning of Informatics workforce
requirements, & expand recruitment sources
• Confirm professional leadership arrangements
Developing the
informatics workforce
Attraction,
motivation
and retention
Performance
management
• Generate excitement around a rewarding Informatics career
• Ensure management commitment to supporting Informatics
staff
• Strengthen competitive position of critical informatics roles
• Local consideration of recruitment and retention premia,
consistent with Agenda for Change
• Attract and develop more individuals through the existing
graduate training scheme
• Develop informatics apprenticeship & talent management
schemes
• Reinforce expectations & accountability for individual
performance
• Introduce strong performance feedback systems to promote
personal growth
• Develop mechanisms for providing assurance about
informatics services, processes & people
Conclusions
Key messages - 1
• Information and IT are central to:
improving health and social care services
empowering service users and staff
• Investment in IT allows a leap forwards in the scope,
availability & use of information
• Emphasis on information about the quality of care,
for patients, the public and staff
• Renewed focus on delivering systems now to meet
clinical priorities
Key messages - 2
• New CIO for Health:
reporting to NHS CEO
on NHS Management Board
underlines importance of informatics & provides a
model for the NHS
• Recognition of the importance of informatics skills
& new impetus to developing the informatics
profession and workforce
Key messages - 3
• NHS Connecting for Health:
 Centre of IT expertise for NHS, not just implementers of NPfIT
 Embrace private & voluntary healthcare providers, & Social Care
• Information Centre for health and social care:
 Maximise the value of data collected
Improve data quality
Encourage data re-use through a ‘syndication service’,
Promote access through information signposting service
 Encourage innovation in the information and data analysis
markets
 Be the source of data for DH, CQC and other official statistics.
HIR next steps
• Specific action plans – business cases,
procurement, implementation etc
• Implementation by the autumn, aimed more at
informatics specialists, with detailed update & plans
• Continued stakeholder engagement
• Embed as “business as usual”
Your questions?
ASSIST NW
30 Oct 2008
Independent Health IT
Policy Review
Brian Derry
Chair of ASSIST National Council
ASSIST
Association for Informatics
Professionals in Health
and Social Care
Remit of the Review
ASSIST NW
30 Oct 2008
ASSIST
Association for Informatics
Professionals in Health
and Social Care
• Establish how clinical, public, and management
needs can most effectively be met by information
technology
• In the light of the developments and progress of the
last few years, establish a vision for IT in the NHS,
health and social care
• Set out a strategy for achieving that vision
including a workforce strategy
• Advise on action for the current Government to
take
• Advise on the policy options to be considered for
implementation by an incoming Conservative
Government
The Review Group
ASSIST NW
30 Oct 2008
• Dr Glyn M Hayes - GP, BCS &
UKCHIP
• Gail Beer - Independent Consultant
• Iain Carpenter, MD FRCP - Clinical
Lead on Record Standards, Health
Informatics Unit, Royal College of
Physicians
ASSIST
Association for Informatics
Professionals in Health
and Social Care
• Ian Shepherd, MRPharmS, FBCS,
CITP
Set questions - 1
• Strategy
ASSIST NW
• What are the strategic objectives that can be supported through
30 Oct 2008
use of IT and information in health and social care?
ASSIST
Association for Informatics
Professionals in Health
and Social Care
• Capture and use of clinical data for individual patient
management
What are the advantages and disadvantages of using personcentred data captured in patient-focused records?
• How should patient and service user outcomes best be
measured?
• What are the benefits and disbenefits of patient and service
user recorded outcome measures?
• Who should perform the necessary data capture, how should it
be done, and how can accuracy be ensured?
• What are the key issues with regard to data quality?
• How important will it be to introduce professionally-agreed
clinical standards for the data captured in patient records?
Set questions - 2
ASSIST NW
30 Oct 2008
• Patients
• How are those who are disadvantaged, have a disability or are not
computer literate affected by the increased use of IT in the
delivery of health and social care?
• Management of the NHS, health and social care
• How can the delivery of health and social care be better
supported by IT?
• How should data to support the management of health and social
care be derived?
• How could IT support commissioning in health and social care?
• Health and Social Care
• How could information be beneficially shared between health
and social care?
ASSIST
Association for Informatics
Professionals in Health
and Social Care
• Information Governance
• What are the relevant issues and tradeoffs with regard to security,
confidentiality and data governance?
Who should have primary responsibility for the content of a
shared record?
Set questions - 3
ASSIST NW
30 Oct 2008
ASSIST
Association for Informatics
Professionals in Health
and Social Care
• The approach to system architecture
• What is right balance between centralised and
decentralised systems?
• Should systems be designed and built to support specific
diseases, interventions, professional disciplines or patients,
regardless of their clinical problems?
• What future technical developments could affect the use of
IT in health and social care?
• What role might other informatics models play (Google
Health, MS Vault, open source etc)?
• What role, responsibilities and structure might a national
centralised IT support body have?
• How can the system procurement process be optimised to
maximise and sustain benefits?
Set questions - 4
ASSIST NW
30 Oct 2008
ASSIST
Association for Informatics
Professionals in Health
and Social Care
• Evaluation
• How should new and existing systems be evaluated?
• Leadership and Human Resources
• How can professional leadership be best developed and used
to encourage the effective use of health and social care
informatics and to support patient and service user care?
• How can staff commitment be maximised at the local level?
• How should the change process be managed?
What education and training will health and social care staff
need?
• How are the workforce in health and social care affected by
the increased use of IT?
ASSIST process
ASSIST NW
30 Oct 2008
• Workshop, 24 September:
30 senior informaticians: NHS, CFH, IC,
academia
Facilitated by John Farenden, Tribal
Consulting, under MOU with ASSIST
Written contributions/comments
ASSIST
Association for Informatics
Professionals in Health
and Social Care
• Report submitted 30 September
• Publicity – e Health Insider, Computer
Weekly, Public Servant
ASSIST themes -1
ASSIST NW
30 Oct 2008
• Vision unchanged: detailed, personcentric, securely accessible electronic
records across health & social care
• Pervasive IT & public expectations:
 NHS & banking
• Building confidence – public & staff
ASSIST
Association for Informatics
Professionals in Health
and Social Care
 Media negativity
 “NHS supercomputer”
 Blaming & schadenfreude
ASSIST themes -2
ASSIST NW
30 Oct 2008
• Unifying concept – patient encounter
• Standards rather than standardisation
• Balancing local & national:
 One size does not fit all
 Responsibilities to wider community
• Building confidence:
 Openness & transparency
 Building on success & learning from problems
ASSIST
Association for Informatics
Professionals in Health
and Social Care
• Encouraging SME suppliers
ASSIST recommendations -1
ASSIST NW
30 Oct 2008
• Get the basics resolved before trying the ambitious
• Do not lose or threaten the hard won successes
• Focus on (person-centred) standards
• Achieve a balance between technology, systems, people,
process and culture
• Ensure much earlier and more integrated policy
planning at both national and local levels
ASSIST
Association for Informatics
Professionals in Health
and Social Care
ASSIST recommendations -2
ASSIST NW
30 Oct 2008
• Invest in a systematic health
informatics R&D programme
• Avoid structural change
• Avoid stand-alone data demands
• Avoid insular systems development
ASSIST
Association for Informatics
Professionals in Health
and Social Care
• Invest in developing informatics
skills, leadership and the profession
Questions to you
ASSIST NW
30 Oct 2008
ASSIST
Association for Informatics
Professionals in Health
and Social Care
• Is our broad analysis right?
• Are our recommendations right?
• What more can we all do to help
advance the cause of informatics?