What the NHS Care Records Service will mean for Primary Care

1. What the NHS Care Records Service will mean for Primary Care Paul Charnley and Dr Mike Bainbridge

2. What the NHS Care Records Service will mean for Primary Care Paul Charnley Regional Implementation Director North West and West Midlands Cluster

3. Overview of Presentation • NPfIT – Overview of the Programme NHS CRS and Primary Care – Current thoughts from a Cluster Practical Issues – the benefits in prospect and implementation issues that face us. • Confidentiality and Security • Data quality • eBooking • Electronic Transfer of Prescriptions • Electronic requests and results • Change to patient centric records –access and choice • Secondary uses - New GP Contract

4. Who is doing what? NPfIT - Overall NHS project development and management on behalf of the DoH NHS CRS Programme – Development of the Service and specialist input into NPfIT Clusters – ‘Localised’ NHS implementation management within each of the 5 locations for all NPfIT programmes NASP – Contractor: ‘BT’–Delivering the National Aspects of the NHS Data ‘Spine’ LSP’s – Contracts awarded – Deliver the products to support the services within a cluster Local IM&T – Including local CIO’s – support delivery directly to services, liaison between LSP’s and workforce

5. Introduction – The NHS Care Record • Will enable details of the key events of a persons healthcare history throughout their life to be; • collected, stored & retrieved • made available at all times • across the whole country • to those with authority to view A better use of information and communication technology within the NHS would improve efficiency and cut costs Wanless Report April 2002

6. NASP (National Application Service Provider) • NASP contract awarded to BT • Responsible for delivering nationwide aspects of NHS Care Record Service; • NHS CRS Data Spine • Secondary Uses Data warehouse Main Data Spine components • Transaction Messaging Service (TMS) - Manages messages in / out • Personal Spine Information Service (PSIS) – Holds all clinical messages • Personal Demographic Service (PDS) – Information for patient identification

7. Personal Demographic Service Personal Spine Information Service Data Spine Directory Service Patient Details Patient Details Messages eBooking eBooking Clinical Messages Clinical Messages eTP eTP Processes/ Logic Transaction Messaging Service Terminology Services Workflow & Rules Service Other Links Links to ‘Health Space’ Links to National Services Links to Remote Settings Interfaces Secondary Uses Services Applications Clinical Applications (View) Clinical Applications (Input) Replacement NWCS Business continuity and DR Data Quality & Data Quality Management Access and Control Infrastructure/ Services Help Desk Patients Help Desk NHS NHS Care Record Spine – Components The technical Infrastructure

8. LSP (Local Service Provider) • LSP contracts awarded to • BT – London - IDX • Accenture – North East and East - iSoft CSC – North West & West Midlands – iSoft Fujitsu – South and South West - IDX

9. LSP (Local Service Provider) Main Local NHS Care Record Service components (Core Bundles) (Different iSoft/IDX) 1 Connectivity, Messaging and Access to PSIS and Spine Directory and eBooking Messaging 2 ICRS Set up and Basic Patient Administration within each Care Setting 3 Assessment & Clinical Documentation (including social care & elements of NSF's) 4 Clinical Support Services - Requesting & Order Communication, Decision Support and ePrescribing 5 Scheduling (including scheduling elements of NSF's) 6 Integrated Care Pathways and Care Planning (including elements of NSF's, e.g. CPA)

10. LSP (Local Service Provider) Main Local NHS Care Record Service components (Core Bundles) (Different iSoft/IDX) 7 Maternity 8 Information for Secondary purposes (including elements of NSF's) 9 Emergency/Unscheduled Care 10 Surgical Interventions 11Alternative Options for GP's 12 Prevention, screening, surveillance includes elements of NSF's 13 Ambulance

11. LSP (Local Service Provider) Main Local NHS Care Record Service components (Additional Bundles) (Different iSoft/IDX) • PACS and Medical Imaging • Radiology • Pathology • Financial Payments • eHealth • Document Management • Dental • Pharmacy Stock Control • Prevention, screening, surveillance • Social Care • Decision Support Advanced • Long term medical conditions

12. Personal Demographic Service (PDS) Personal Spine Information Service (PSIS) Decision Support User Tools Request & Order Communication Care Management Patient Index Scheduling eBooking eBooking Prevention, scheduling & surveillance Electronic Transfer Of Prescriptions Prescribing & Pharmacy Document Management Results Reporting Clinical Documentation Care Pathways & Planning Assessment PACS Service Components NASP LSP Transaction Messaging Service (TMS)

13. Phasing - Overview A phased delivery is necessary to; • Meet NHS targets • NSF targets, e.g. SAP • Facilitate delivery of a reliable stable national architecture • Manage affordability • Support an achievable delivery across the country

14. Phasing • Phase 1 • Release 1 - June 2004 • Release 2 – Dec 2004 • Phase 2 • Release 1 - June 2005 • Release 2 - June 2006 • Phase 3 • December 2010 Phase 1 • Access to information • Passive, viewing of data • Implementation of specific targets Phases 2 and 3 • Active support for care provision • Order communications, prescribing, scheduling • Full functionality

15. PMIP EBS NHS CRS ETP Technical Infrastructure – Expected Take-up

16. Solution Architecture NASP eBooking PDS PSIS eTP Transaction Messaging Service LSP Cluster wide Data Repository SeeBeyond Integration Bus EMIS PCS Torex PSE InPractise Vision iSoft i.EPR / Lorenzo Niche Portal

17. Wrapper Messages Messages Data Centre Local NCRS Local NCRS Wrapper eBooking PDS Primary Care System Other LSP Services PSIS eTP Local NCRS Local NCRS eBooking PDS Integrated Services PSIS eTP Primary Care - Evolution and Choice Practice Primary Care System

18. Migration and Choice Current Situation Multiple Practice Systems with a few bureaux ? ? ? ? 04-06 Tactical Hosted Bureaux Service Messaging compliant Not all system types supported Not all practices migrated 06 onwards - Strategic position Primary Care Solution part of the Integrated NHS Care Record Service Lorenzo ?

19. Primary Care has a rich history of successful electronic patient records development and use Standards (RFA) Registrations (IOS) Appointments Longitudinal record Support for prescribing Audit and NSFs Impact on Primary Care … more

20. Records in Practice only Wider primary care may or may not have access Links to the rest of NHS Results Requests/Referrals Prescriptions New models of care – Tier2/ Intermediate/ GP with Special Interest Out of hours/ unscheduled care NHSNet constraints Issues for Primary Care … more

21. Issues/Implementation • Confidentiality and Security • Data quality • eBooking • Electronic Transfer of Prescriptions • Electronic requests and results • Change to patient centric records –access and choice • Secondary uses - New GP Contract

22. ICRS Data Sharing Patient Access Legitimate Relationships Sealed Envelopes Role Based Access Control Other Access Controls Audit Trails User Registration User Authentication PseudonymisationService Secure Communications Compliance Information Governance 12 principal topics

23. A balance of benefits versus risks Protecting patients’ concerns without imposing impossible burdens on care delivery Caldicott Guardian principles will govern all data usage Plans in-hand for healthcare information governance service Security Password / smart-card protection Audit trail for all ‘transactions’ – traces computer, user, activities performed / data accessed Information Governance 0203_01:32 Patient W. Nurse A – New Record 0203_01:32 Patient C. Nurse F – Medication 0203_01:33 Patient X. Doctor C – Test Result 0203_01:33 Patient X. Doctor C – Clinical Note 0203_01:33 Patient A. Patient A - Discharge … more

24. Confidentiality Rigorous role-based access controls Patient choice - electronic sealed envelope for highly sensitive information (expected during Phase 2) Professional & employee codes of conduct to govern usage Information sharing Based on protocols & legitimate care relationships Patients able to ‘opt-out’ of consent to share information externally (i.e. Social Services) Information Governance 0203_01:32 Patient W. Nurse A – New Record 0203_01:32 Patient C. Nurse F – Medication 0203_01:33 Patient X. Doctor C – Test Result 0203_01:33 Patient X. Doctor C – Clinical Note 0203_01:33 Patient A. Patient A - Discharge

25. Good work done by PRIMIS in this area Ensure data is “Fit” for purpose To build record gradually or complete it with “downloads”? Patient registers Summarized records Extending content e.g. additional members of the primary care team Use of NHS Number Data Quality

26. For the benefits of patients Shift of tasks around the health communities First high profile implementation Starts small with early adopters and grows Longer term plans Within PCTs Integrated with scheduling and Integrated care pathways eBooking

27. Underway but awaiting details of the new pharmacist contract Current manual process duplicates, introduces errors Repeat prescriptions Physical “token” Electronic Transfer of Prescriptions 0203_01:32 Patient W. Nurse A – New Record 0203_01:32 Patient C. Nurse F – Medication 0203_01:33 Patient X. Doctor C – Test Result 0203_01:33 Patient X. Doctor C – Clinical Note 0203_01:33 Patient A. Patient A - Discharge

28. Efficiency and safety Reducing duplication Pathology results started will be included Other results scheduled for P1R2 Requests – guidance and protocols Less error in processing the requests Electronic requests and results

29. Change to patient centric records –access and choice Healthcare services Care settings Health economy

30. National Scope Clusters Clinical Network SHA Organisation Local Health Community Secondary uses – e.g New GP Contract Pseudonomysed data set for analysis

31. Your support is vital to make this happen – You have the opportunity to; Be involved in a process that will truly modernise the NHS Make it happen successfully both locally and nationally Enhance the position of informatics as a profession Support the development of a unique clinical infrastructure Support the delivery of a service that will have real benefits for patient care Supporting Implementation