1. https://nww.stuff.nhs.uk Or Whither NHS net

2. Why? • Long personal involvement • Central to all the changes that surround us • Knowledge is power • Pretending it isn’t going to affect us is not an option

3. Why? • Not for coding clerks. • Who don’t have a long term future. • Not just for the IT department. • For us all, clinical workers and management workers alike.

4. What? • The NHS plan. • Information for health. • 1998 • Our LIS. • Our local funding. • Building the information core. • Jan 2001. • Other bits from all over.

5. Strands in All This • Communications • Records • Information

6. Strands in All This • Maybe money?

7. New Ways of Working • Not bolting computers onto existing practices • About redesigning work • Redesigning care • New pathways in the jargon

8. Secondary care Clinical and support staff; 25% have desktop access by now Really is 20% ‘ish 100% by 2002 Primary care GPs and managers 95% practices connected by now Really is 80% ‘ish 90% desktop access by now Really 50% ‘ish All 100% by 2002 NET Targets But but but but but !

9. Email Net browsing Information source Fax out (doesn’t work!) NSTS (not that reliable!) Reading the stuff the NHSe no longer publishes – cures insomnia. National address book? GP registration links. GP IOS links – for the brave. Uses Now

10. Security • Lags behind • Caldicott • Awareness • Safe havens etc etc • National audit scheduled for Dec 2001 • To BS7799 • NHS cryptography • Roll out spring 2002 • Public key encryption

11. What Next? – Uses of NHS net • National priorities are pathology requests and reports. • Then xray reports and requests. • Booking. • Discharge information.

12. Jargon EPR • Electronic Patient Record • ? Attainable EHR • Electronic health record • ? Holy grail

13. Clinical Terminologies • Coding viz classifications • Read 3 • Ends 2003 • SNOMED – CT • Starts 2003 • ? Legacy coding and classifications

14. EPR Level 3 • Integrated patient master index. • PAS. • Departmental systems (all departments) • Electronic clinical orders and results reporting. • Prescribing software. • Multi-professional care pathways.

15. EPR – Primary Care • RFA99 legalises electronic records. • RFA99 roughly equates with levels 4-5 of secondary care EPRs. • Big problem is hospital letters. • ? Scanning. • ? EDI. ? 90% of practices by 2003

16. EPR – Primary Care • Integrated nursing and medical EPRs are coming. • National framework expected in Sept 2001. • End of many Korner MDS expected in next month or two. • Local initiatives already underway.

17. EPR – Out of Hours • National programme • To make summaries of GP EPRs available 24 hours a day • First to GP out of hours services • Then to A+E departments • ?? 2005

18. EPR – Mental Health • Separate plans for mental health EPR. • Separate funding stream. • Integrated social and health records. • Shared with social services. • 25% by 2003 ? • Locally ahead of the game.

19. EPR – Acute Hospitals • Weird set of levels defined by the NHS • 35% of acute trusts to have a level 3 EPR by 2002 • 100% by 2005 • Plenty of words and management speak out here – few systems!

20. Local Status • 9 practices have full desktop NHS net connection. • All practices should be connected by end of year. • 16 practices have new LANs. • 6 practices “paperless.” • 5 practices going “paperless.”

21. Local Status • FHN has connection. • FHN has too poor a LAN for full desktop access. • We have started a project for pathology reporting and requesting. • We hope to add in radiology soon. • Networking information sources is proceeding.

22. Information • NICE • NeLH • Protocols • Policies • Guidelines • HiMPs • CHiMPs And uncle tom cobbly….

23. Payroll and HR • A national payroll and HR system is planned to start rolling out in 2004. • Doing away with individual organisational arrangements.

24. Caveats • Knowing that nurses share the same records and can rapidly communicate with doctors will allow more task sharing, profoundly changing the nature of medical work.

25. Caveats • A lush information landscape where information is shared with patients leaves some things unknown: • If 1% of patients join the worried well? • Sharing all records with patients?

26. Caveats • How much extra time to spend capturing and structuring records?[1] – 30 minutes plus per day. • [1] Tierney et al JAMA 1993;269:379-83.

27. Caveats • Are we ready to share our information with patients ? • The strategy says there are irresistible arguments for this.

28. Caveats • Control • Governance • Accreditation (and Re- ) • Performance related pay • Politics Or just my depixol dose is late.

29. A Personal Hope Clinical Needs Not Technology for its own sake