IT in Health?

1. IT in Health? BCS North London Branch March 2006

2. Ewan Davis Chairman - BCS Primary HealthCare Group www.phcsg.org Vice Chairman – Intellect Healthcare Group www.intellectuk.org Director - Woodcote Consulting Ltd www.woodcote-consulting.com ewan@woodcote-consulting.com

3. An Apology – TLAs and FAD • FAD = Fatal Acronym Density. The point at which the number of acronyms in a document or presentation reaches the level at which the document or presentation is no longer capable of conveying meaning

4. Background • Changing demographics • Aging population increasing numbers needing care while reduce numbers available to deliver and pay for it • Increasingly capable medical technologies • Medicines • Genomics • Medical devices • New techniques and procedures • Greater citizen expectations

5. UK National Health Service • Universal provision substantially free at the point of use • Recent history • Middle ranking quality both in terms of outcomes and service • Low cost • Good value for money (compared to other developed countries)

6. UK NHS … • Substantial new investment lifting expenditure towards European mean (from 7% to 10% of GDP) • £56 Bn 2003 • £90 Bn 2008 • £100 Bn 2012 ? (i.e double the cash in 10 years) • Where has the cash gone • More facilities • More staff • Better pay (including a significant unplanned and unjustifiable element)

7. What is the NHS • Not a corporate body • Consisting of: • 900 legal entities (Trusts, Health Authorities, Others) • 40,000 independent contracts (GP practices, pharmacies, dental surgeries, opticians shops) • 1.3 million employees the (worlds 3rd largest) • An unknown number of partners and suppliers working primarily for the NHS • Works closely with many other governmental , commercial and independent sector organisation in social care, education, criminal justice, healthcare provision, supplies and research. • No clear boundary • Maybe a federation • Probably more like a supply chain

8. UK NHS … • What’s been delivered • Some improvements in outcomes and service • Some necessary infrastructure improvements and service reconfiguration • Not enough (yet?)

9. Policy Approach • Stick with NHS founding principles – Free at point of use – Funded out of general taxation • Increase expenditure towards European mean • Seek radical workforce and service modernisation • Complete the purchaser provider split and encourage more NHS provision by non-NHS bodies

10. Policy Elements • Choice, competition and contestability • Practice based commissioning, payment by results, direct payments - Money follows patients • Greater involvement of the independent sector • Greater autonomy for NHS organisations • Care closer to patients • More services in primary care • New providers outside hospitals • Assistive technologies • Workforce modernisation • Breaking down professional divides • Making better use of available skills • New classes of healthcare workers

11. Policy Elements … • Preventative medicine and Managed care • Keeping people healthy • Keeping the chronically ill stable and productive • Avoiding crisis interventions • Better integration between health and social care • Risk Management • Patient Safety • Negligence litigation • Patient self-care • Patient access to records and information • The expert patient • Support for carers

12. The Common Theme? • A new IT Infrastructure to share knowledge, patient records, and workflows across the health care supply chain.

13. The Commitment • To provide the NHS with the IT it needs to transform the way healthcare is delivered • To raise NHS IT spend to 4% of NHS revenue by 2008 (from a base of 1.7%) • Equates to £30 bn over the 10 years of the NPfIT • £6.3 bn allocated to the NPfIT in England. The biggest ever civil IT programme in the world

14. The NPfIT Vision • To provide secure, appropriate and timely access to all those concerned with the delivery of care to an individual to relevantparts of that individuals care records where and when needed to ensure good quality and efficient care delivered in a Medico-legally robust manner. • To provide workflow management and decision support tools to support the patient’s journey along the mostappropriateclinical pathway within and across organisational boundaries in a way that delivers quality care;convenient service and makes the best use of NHS resources. • To provide patients and carers with appropriate access to the information and knowledge they need to play an active role in their own care or that of the person they care for.

15. The Plan • Provide enterprise wide EHR systems covering regional health economies linked to a national spine and national services. • National services to include • A new National Network (N3) • A National Care Record Service • Electronic Booking - Choose & Book • An Electronic Prescribing Service • A Secondary Uses Service (Data warehouse)

16. N3 • To replace the existing NHSnet with a broadband service • To support the national services • To support NHS the Intranet (nww) and NHS email service (Connect) • To provide the NHS with Internet access • To provide WAN connections between NHS sites

17. National Care Record Service • A national spine providing: • Patient demographics (PDS) • Summary EPR (PSIS) • Security services (SoS, RBAC, LRs) • Transaction brokerage service for other national services • An integrated, shared patient record across local (regional) health economies • A patient portal (www.myhealthspace.nhs.uk) • A feed of pseudo-anonymised data to the SUS

18. Choose and Book • To support the creation of a fully bookable NHS • To support electronic referrals by GPs • To support patient choice • Eventually to enable patients to book electronically in to front line services (GP practices etc)

19. Electronic Prescription Service • Enabling prescription to flow electronically from primary care prescribers to pharmacies and the reimbursement agency • To enhance safety • To improve convenience and efficiency (particularly in relation to repeat prescribing and repeat dispensing) • To populate prescribing records on PSIS

20. Secondary Uses Service • To create a data warehouse of pseudo-anonymised NHS data for management and research proposes • Eventually drawing its data from the NCRS but initially absorbing legacy systems (NWCS, HES) • Initial priority is to support Payment by Results

21. Progress to Date • N3 well established • QMAS added to national services and 100% rolled out • Initial implementation of EPS and C&B in place • Single system approach abandoned in the south and diluted in the north • GP system choice confirmed

22. Progress to Date …. • NCRS focus now on national summary record, but not implemented yet. • Little impact on acute EPR provision • Provision of PACS systems added and rolling out • National email service added and rolling out • GP2GP record transfer service added and in pilot • SUS absorbing pre-existing services but no feed from NCRS yet

23. Future Direction • Further redefinition and refocusing of CfH aims and objectives likely • Likely continuing shift from homogeneous to heterogeneous model. Enterprise system to Enterprise Architecture (SOA) • Slow progress to NCRS with greater focus in integration of existing systems

24. Issues • Are the issues in the health care domain unusually complex? • Is the NPfIT trying to solve the right problem? • Are either the right problem or the one that the NPfIT is trying to solve solvable? • How will issues of patient consent and confidentiality be resolved? • How do you effectively combine world class IT skills with healthcare domain expertise? • Will the Government deliver on its 4% commitment

25. Some Parting Facts • Over a million critical process occur in the NHS every day • 50-75% of healthcare cost are incurred in the last year of life (99% in the last 10 minutes if you are lucky) • 10% of hospital admissions result from deliberate self-harm • 10% of patients treated will be seriously unintentionally harmed by the NHS. This leads to suffering, disability and death and costs the NHS 2bn pa in extra hospital costs. Negligence claims settled in 2003/4 cost £423 m with a total provision for outstanding claims in excess of £2 bn

26. More Information • www.nhscfh.nhs.uk • www.capitalcarealliance • www.bcs • www.phcsg.org • www.intellectuk.org

27. Ewan Davis Chairman - BCS Primary HealthCare Group www.phcsg.org Vice Chairman – Intellect Healthcare Group www.intellectuk.org Director - Woodcote Consulting Ltd www.woodcote-consulting.com ewan@woodcote-consulting.com