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RAISING THE ROOF National Patient Records Analysis Service (NPRAS)

RAISING THE ROOF National Patient Records Analysis Service (NPRAS). Gwyn Thomas NHS Information Authority. CHALLENGES TO HEALTHCARE. Diverse, more efficient provision of care. Increasing demand. Insufficient capacity. Patient-focused service. Changing expectation. Dissatisfaction.

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RAISING THE ROOF National Patient Records Analysis Service (NPRAS)

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  1. RAISING THE ROOFNational Patient RecordsAnalysis Service(NPRAS) Gwyn Thomas NHS Information Authority

  2. CHALLENGES TO HEALTHCARE Diverse, more efficient provision of care Increasing demand Insufficient capacity Patient-focused service Changing expectation Dissatisfaction Knowledge, Process and outcome management Growing Complexity -medical - organisational Inconsistent Quality, Confusion

  3. FUTURE PATIENTS* • Better Informed • More personally accountable • Less uniform in attitudeand will expect ……. • Waiting within reason • Safe, effective equitable service • Hotel Services • An integrated, joined up system *McKinsey 2002

  4. EXPERIENCING HEALTHCARE • Patient experience • Confidential journey along a care pathway • Provider / user experience • Standard Tools to do their job • Organisation experience • Effective & efficient management

  5. MAKING THE SYSTEM WORK – NATIONALLY • Health Provider • Where Care is given • Health Network • Where Specific Care is Integrated • Health System • Where Overall Integrity is Secured Values Clinical standards Workforce / networks Information

  6. INTEGRATING THE HEALTHCARE SYSTEM – THE ROLE OF THE INFORMATION AUTHORITY Providing National Information Services for the NHS Supporting Local Communities Implementing National Strategy Supporting Health Networks

  7. DELIVERING 21ST CENTURY IT VISION • support the delivery of care and services designed around each patient’s choice, quickly, conveniently and seamlessly • support staff through electronic communications, better knowledge management and support, faster access to essential information (notes, test results) and routine access to specialised expertise • improve the management of services by providing good quality data to support NSFs, clinical governance and management information

  8. User Specific Functions NSFs Environment Information Diabetes Community Pathology Mental Health Social Care Acute Care Primary / Capture Mental Health Information Reporting Generic Functions Older People Analysis Knowledge Management Cancer Digital Imaging Prescribing User Tools CHD Ordering & Reporting Booking and Scheduling Information Diagnosis and Care Governance Service User Index Analytical NHS Direct Population Reference Decision HRI Nhs uk NeLH Services CAS Record Files Support Application Services Information Services Access eStaff Network Security E-mail Directory Finance Control Record Infrastructure Services ICRS - Linking Up Health Communities Health Community THE NATIONAL PROGRAMME National Infrastructure NHS INFORMATION AUTHORITY “THE NATIONAL SERVICE PROVIDER”

  9. INFORMATION SERVICES OF THE NATIONAL HEALTH SYSTEMFour Elements • CONTEXT – Health Services Providers • common descriptions and details of services and providers within the health system, their configurations and locations • INTENT – Standards for Health Services • Using clinical knowledge and adopting standards of care across the health system e.g. National electronic Library for Health • ACTIONS– Personal Health Management • electronic records, e-bookings, referrals, investigations, and prescriptions • OUTCOMES– Measuring Performance of Health Services • consistent support of the clinical audit of individual care Where can I go? What will they (we) do? What did they (we) decide? Did it do any good?

  10. HRI NHAIS NWCS nhs.uk NSTS NeLH NHS directory 3. Performance of health services 4. Standards for health services 1. Health Service Providers 2. Personal health management Where can I go? What will they do? What did they decide? Did it do any good? National Health System Interface NATIONAL INFORMATION SERVICES – REALISATION (1)

  11. NATIONAL INFORMATION SERVICES – REALISATION (2) CCAD NATIONAL PATIENT RECORDS ANALYSIS SERVICE M I G R A T I O N NCASP PAT & OSCAR CLIN. GOV. TOOLKIT ELDERLY CARE NSF TOOLKIT HEALTHCHECK TOOLKIT MENTAL HEALTH CAPACITY PLANNING PRIMIS NWCS REPROCUREMENT

  12. NATIONAL CLEARING SYSTEM LOCAL CARE RECORD SYSTEMS EDUCATION & TRAINING CHANGING PRACTICE NATIONAL PATIENT RECORD ANALYSIS SERVICE NATIONAL ANALYTICAL SERVICES WEB BASED ANALYTICAL TOOLKITS

  13. NATIONAL PATIENT RECORD ANALYSIS SERVICE – Potential benefits • Easier access to nationally consistent analyses on patient activity • Greater sharing of information to allow comparative analysis • More cohesive views of patients receiving healthcare services wherever it occurs • Capability to undertake key national analyses once only • Improved availability of aggregated patient activity across the whole healthcare system • Improved record linkage for audit across the whole care pathway • Opportunity to provide a coherent framework for existing disparate systems

  14. Operational / Direct Care Audit / Performance review Strategic / Planning Tactical ICRS Local / National – Patient Record Analysis Services BusinessRequirements Examples of characteristics of requirements • Identifiable records • for Individual • persons • Immediate access • Dynamic, up to date • Frequent abstracts • Focus on classes • of persons • Time series • Short time intervals • Prospective indic- ators • Focus on classes • of patients • Actual compared with expected • (inputs, outcomes) • Ongoing • Indicators • Focus on classes • of patients • Service and pop. • based • Forecasting • Periodic

  15. Operational / Direct Care Audit / Performance review Strategic / Planning Tactical BusinessRequirements

  16. Operational / Direct Care Audit / Performance review Strategic / Planning Tactical BusinessRequirements

  17. Operational / Direct Care Audit / Performance review Strategic / Planning Tactical BusinessRequirements

  18. Characteristics of the Service Comprehensive Responsive Easily accessible Cost effective and value for money Secure Accurate Timely Relevant and fit for purpose Flexible Investment Objectives Improve user access to data to meet business needs Secure consistency in data available Improve coverage and quality of data Improve security of data Prevent duplicate abstraction Enable greater public involvement in decision making Enable users to improve services NPRAS Characteristics and Objectives

  19. NPRASPreferred Option • Mapping & reference services • Data management • Access through consistent user interface • Aggregated data • Data extracts for indicator construction • Extended data to include aggregate & population data • Standard analysis & reporting • Analysis tools & models

  20. NPRAS – Trials • Understand the practical implementation issues of using electronic records for secondary analysis • Sharing models & options for delivering NPRAS type functionality using electronic records as the data source • Demonstrate how to link local records systems with national systems (e.g. NWCS) for analytical information

  21. NPRAS – Trials • Bradford - • consolidation of disparate GP systems • analysis of primary care data • Cornwall - • community wide management & clinical analysis • developing electronic links for data analysis (Cornwall wide & national flows) • Dorset - consolidating PCT & GP systems for • clinical governance (CHD) • management information (prescribing vs dispensing)

  22. NPRAS – Trials • Hampshire & IoW - • analytical information from various hospital based systems, NHS Direct, Ambulance, Social Services to support clinical governance • Walsall - • supporting NSFs and clinical governance using primary and secondary care data • Wirral - • using Trust systems and electronic records across hospital systems for analysis

  23. Key messages from NPRAS Trials • Issues needing to be resolved at national level • National information standards which are enforced • Pseudonymisation protocols • Information sharing protocols with non-NHS organisations • Primary Care ‘Dataset’ based upon new GP contract • ‘Push’ model is more effective & efficient than ‘pull’ for a service as complex as healthcare analysis • Provide for accredited analytical software tools or procure single supplier for analytical software tools • Rationalise & ensure consistent core requirements across NSFs

  24. Key messages from NPRAS Trials • Issues needing to be resolved at local level • clinician involvement & buy-in • data quality & integrity to develop ‘trusted’ information • continual training & education for local staff (users/data suppliers) • adherence to national standards even if different from current practice • active use of the information to support decision-making processes • investment in systems and people

  25. Key messages from NPRAS Trials • Other issues needing to be resolved • Relationship between local analytical services (systems & people) & NPRAS • Ensuring that funding is available to support local requirements to use NPRAS as well as national level funding • Being clear about the relationship between current systems/services with similar functionality with NPRAS (e.g. OSCAR, NCASP, Dr Foster), and identifying migration & implementation timetables • Start with data that already exists, link it, use it and improve it

  26. NWCS – ‘Mk 2’ NATIONAL CLEARING SYSTEM Current Assets & ICRS LOCAL CARE RECORD SYSTEMS NHSIA NATIONAL ANALYTICAL SERVICES WEB BASED ANALYTICAL TOOLKITS NHSIA/SUPPLIER PARTNERSHIPS NHSIA/NHS PARTNERSHIPS EDUCATION & TRAINING CHANGING PRACTICE MAKING IT HAPPEN …

  27. RAISING THE ROOFNational Patient RecordsAnalysis Service(NPRAS) Gwyn Thomas NHS Information Authority

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