Challenges & Opportunities for Distributed ICT in the NHS in England

1. Challenges & Opportunities for Distributed ICT in the NHS in England Dr Mark Ferrar Director of Infrastructure, NHS

2. And in the next half hour... • Scale • Consistency • Connectivity • Collaboration • Identity

3. Scale

4. In a typical week... • 6 million people visit their GP • Over 800,000 outpatients are treated • Over 10,000 babies are delivered by the NHS • Over 50,000 emergency journeys in NHS ambulances • District nurses make over 600,000 home visits • Pharmacists dispense ~8.5 million items • NHS surgeons performing ~1,200 hip operations, 3,000 heart operations and 1,050 kidney operations • Labs & associated services process millions of tests • That’s over 3 million critical transactions per day!

5. And in ICT... • 700,000 PCs and 850,000 computer users in the NHS (in England) • NHSmail has over 400,000 users • Amongst the world’s largest private, fully-featured, secure, single-domain e-mail services • NHSmail Relay Service processes 4,000,000 messages/day and activity bursts of 100 messages a second. • N3 network transacts almost 100 terabytes of data each month • Equivalent to the 32 volume set of Encyclopaedia Britannica every 40 seconds • The processing power of the NHS “Spine” (& its test environments) are equal to one of the top 100 supercomputers ever built • Over 300 terabytes of storage – like the contents of a book shelf 3000km long

6. And remember the people... Modern, integrated IT systems and services, connecting: • 122,345 doctors • 404,161 nurses • 152,651 other health professionals • Balance of 800,000+ computer system users are in administration functions across the NHS • Most are degree educated or professionally qualified • Most are also highly mobile throughout their work day • Perhaps the largest “mobile knowledge worker” enterprise in the world!

7. Key delivery systems

8. What are "Secondary Uses"? • A considerable amount of information is collected during the provision of care and supporting services • The primary purpose of this information is to support and improve individual patient care • However, this information is of value for many other purposes to support healthcare and providing appropriate steps are taken to meet confidentiality obligations, this information can legitimately be used to support these other purposes. These are called “secondary uses”

9. Identifiable Pseudonymised or Anonymised Primary and Secondary Uses Business Operations Commissioning Analysis / Service Planning Operational Direct Care Strategic / Policy / Research Examples of characteristics of requirements • Individual records • Selected “lists” of • records • Immediate access • Dynamic, up to date • Workflow, rules based • alerts • Frequent abstracts • Focus on classes • of persons • Time series • Short time intervals • Prospective indicators • Focus on classes • of persons • Actual compared with • expected • (inputs, outcomes) • Ongoing • Indicators • Focus on classes or • cohorts • of persons • Disease, Service and • population • based • Forecasting • Periodic

10. Objectives of SUS • To improve access to data to support the business requirements of the NHS and its stakeholders • To provide a range of software tools and functionality which enable users to analyse report and present this data • To be the single, authoritative and comprehensive source of high quality data • To enable linkage of data across all care settings • To ensure the consistent derivation of data items and construction of indicators for analysis • To improve the timeliness of data for analysis purposes • To provide a secure environment which enables patient confidentiality to be maintained according to national standards

11. SUS Information Flows Manual Collection / Submission DH Use Presentation Data Publication ALB Use Local Management Systems Added - value Data Derivations service Collection Calculations Local providers Use Standards National Spine Local Data Source Presentation Users Data Data systems Management Collection

12. Some SUS statistics • 16+ Terabytes of data in SUS • > £30 billion of PbR transactions processed • 700+ million Activity records submitted to SUS • Over 1 million records entering SUS each day • Over 90,000 managed service extract reports produced from SUS • Over 12,000 user-defined extracts produced • Over 1500 users registered • Currently over 320 organisations submitting data

13. Consistency

14. We Can Only Influence Change

15. Remember how the NHS has historically dealt with data...

16. Raising the bar... • “Patchy” NHS IT infrastructure maturity and performance • “Infrastructure Themes” seen in 2005 still exist and some evidence best/worst gap widening • TCO not lowest (or even competitive), despite being the 800lb Gorilla in IT purchasing in EU • A consistent, well-managed desktop is vital for the success of Local & National IT programmes • Premature use of high value technology prohibits lowest TCO and/or maximum benefit being realised soonest

17. Infrastructure Challenges... • Significant cost - according to analysts, 70% of typical IT spend goes on IT Infrastructure! (run the organisation) – (70% of £2.2bn = £1.54bn) • NHS IM&T Managers should not just rely on gut feel when setting investment priorities • Inconsistent terminology makes it difficult to benchmark (TCO) • Organisational changes in the NHS means that many IT infrastructures are in silos and not optimally managed • Some suppliers don’t create infrastructure solutions that NHS Trusts request, actually need or are ready for • Many NHS Trusts need help to build coordinated infrastructure improvement plans • Some key tasks often get overlooked because their impact on infrastructure is not obvious

18. Enabing Consistency... Enable consistency across the NHS in England by: • Providing software through Enterprise Agreements • Latest products at lowest cost • Close relationships with suppliers • Establish “yard stick” against which organisations can measure themselves (and compare with others) • NHS Infrastructure Maturity Model (NIMM) • Common User Interface programme (CUI) • Collaboration Architecture & Solution Enablers (CASE) • Harvest & Share good (best) practice

19. NIMM Summary

20. How should you use the NIMM? • Perform a self assessment using the NIMM • Prioritise and invest to improve lowest scoring areas • Aim for a balanced score, rather than excellence in isolation • Higher value MS EA technologies only available to those with CAPABILITY to exploit them • Leverage capabilities of Core EA products that are licensed for all and don’t default to Enterprise products that aren’t – especially if your organisation isn’t ready to exploit them

21. Collaboration

22. Common Themes – Integrated Projects Responsiveness Re-use Innovation Agility Competency Manage Risk ROI/Business Value Efficiency Consistency Standards

23. What is NHS CASE? Collaboration Architecture Solution Enablers An end to end model to support the development of collaboration solutions A set of candidate solutions described in business terms to help the NHS envision their collaboration capabilities A set of tools which can be used at various stages in developing collaboration solutions A mechanism to share via the PSPG good practices and collaboration solutions

24. What was the driver for NHS CASE? Architectures & Methodologies Technologies CUI Good Practice SSADM Prince 2

25. What was the driver for NHS CASE? Architectures & Methodologies Technologies Business Drive To Collaborate & Share CUI Good Practice SSADM Prince 2

26. What’s in NHS CASE? An end to end model to support the development of collaboration solutions

27. What’s in NHS CASE? A set of tools which can be used at various stages in developing collaboration solutions

28. What’s in NHS CASE? A set of candidate solutions described in business terms to help the NHS envision their collaboration capabilities Single Points of Information Central Document Repository Team Workspaces Information Centre Manager’s Workbench My Workspace Projects & Programmes Secure HR Library Corporate Calendar

29. What’s in NHS CASE? A mechanism to share via the PSPG good practices and collaboration solutions Business Continuity Planning Audit Collaboration Performance Management ?

30. Enabling EWA... • Microsoft • NHS is Microsoft’s largest civilian customer and treated as a “segment of one” – i.e. Uniquely • Most of Microsoft’s collaboration technologies are licensed to the NHS under this deal • Novell • NHS is Novell’s largest global customer • Novell Identity Management and some collaboration technologies are licensed under this deal • Oracle • NHS is a “top 3” global customer for Oracle • Most of the NHS’s centrally held data (e.g. SUS, PSIS) is stored in Oracle databases

31. Innovative solutions... • Groove is a peer-to-peer collaboration environment which is part of Office 2007 Enterprise • 100,000 Groove “seats” currently available for NHS use • Many fewer than that deployed and in use – why? • Groove needs thinking about! • Groove is part of the offering of the Collaboration Environments & Solution Enablers (CASE) work done by Microsoft Enterprise Strategy Consultant working for CFH • Groove is a great product... But... • There are too few Groove solution partners in the UK • NHS is experimenting with Groove, learning from it, learning a new way of working • CFH looking to implement central Groove Relay for the NHS (directory)

32. Key platform updates... • Moving NHSmail service to Microsoft Exchange 2007 • Largest Exchange 2007 implementation of its type in the world • Moves 300,000 active accounts to new service whilst maintaining service continuity. • Engaged end users throughout the design process, ensuring those who’ll use NHSmail have a service that meets their needs • Over 500 servers installed two new secure Data Centres built by C&W • New servers currently undergoing final build & commissioning • Each mail server has 20TB storage and is part of a 3 node geographically diverse cluster (each has dedicated storage) • Over 1300 separate Design Requirements documented in over 2,000 pages

33. Connectivity

34. Architecture Overview

35. Integration Overview ICRS NASP Domain ( Security & Access ) PSIS PDS EPS ACF SDS SSB Secondary Care Application Event Engine/ Event Engine/ Security Integration Layer Integration Layer Infrastructure EPR EPR Primary Care Secondary Care Primary User Secondary User Application Application Enhanced Retained Legacy Systems HL7 V3 ebXML / HL7 V3

36. N3 Users N3 Users Internet Private Circuit Private Circuit DSL DSL Ethernet Access Ethernet Access N3 PoPs Other NHS organisations NHS Direct BT MPLS (N3 IP VPN) COINs Data Centre (Primary) Data Centre (Secondary) Data Centre (Primary) Data Centre (Secondary) 3rd Party Service Provider Local/National Service Provider N3 Architecture Schema

37. N3 Physical Topology

38. CoINs • N3 is not just one Wide Area Network, but many... • Communnity of Interest Networks (CoINs) connect local infrastructures across some Health Communities • CoINs connected by N3 to rest of N3 and other networks

39. Identity

44. Who is an "NHS user"? • Spine Directory uses Sun One • NHSmail uses Active Directory • 65% of 12,000 NOS use Microsoft AD (or NT4!) • 35% of 12,000 NOS use Novell eDirectory (or NDS!) • ESR is Oracle database for most (but not all) NHS workers • An unknown number of application services holding their own username & password lists • ID badges and building access “swipecards” • Telephone exchanges & mobile phones • And web sites and external applications (e.g. Academic systems) • All with different administration and standards

45. Reduce identity chaos... • Reduce user and administrator effort by integrating multiple identities belonging to the same person • Synchronise some identity information • Federate some directory services • Deliver “self-administration” portals for users • Establish provision/de-provision links and processes • Leverage identity proof at the highest level (e-GIF L3) • Make the NHS smart card the “key” to all other identities (if you can’t eliminate them)

46. Summary • Scale • The scale of the NHS provides challenges to data consistency, connectivity, effective collaboration all whilst being sure of a person’s identity (because of confidentiality) • Consistency • Providing enablers and examples of good practice help drive towards consistent infrastructure, systems and data • Connectivity • The connectivity challenge of the NHS is significant – but it is not just about the “wiring” – though that is a challenge in itself • Collaboration • Knowledge workers collaborate – but we need consistent ways to enable that over greater distances and with more people • Identity • The NHS identity management challenge is considerable – organic growth of services must be enabled by effective use of our most “sure” identity services