TARGET 9/6/04 – The NPfIT and You

1. TARGET 9/6/04 – The NPfIT and You (Information and Technology Solutions: Assessing and addressing your own and the teams IT needs.) Dr Phil Griffin (IM&T Clinical Lead)

2. Dr John Reid, Secretary of State for Health, 8th Dec 2003 Who Said This? “By 2010, every NHS patient in England will have an individualelectronic NHS Care Record”

3. A Brief History of Time • Pre-1997 – The Dark Ages • 1997 – All Change • 1998 – “Information For Health” • 2001 – “Building the Information Core” • 2002 – The Wanless Report • More money. Lots more money • Central management of a National Programme • 2002 - Delivering 21st Century IT Support for the NHS • 2003 – The National Programme for IT is born and History starts • 2004 – Clusters are born and a DOCTOR gets involved!

4. WHAT DO THE FOLLOWING HAVE IN COMMON? £265,000 NPfIT Richard Granger

5. Acronym Assassination • DON’T say “EPR” • DON’T say “EHR” • DON’T talk about the “HRI” • Only say “IfH” if you’re really old • Forget “ICRS” (as of 2/12/03) • If you’re hip and happenin, say: NHS Care Record Service

6. NPfIT • A £2.3bn programme over three years to deliver four key elements: • NHS Care Records Service • Electronic appointment booking • Electronic Transmission of Prescriptions • Underpinning IT Infrastructure (N3) • Best use to be made of the existing asset base NPfIT is about patients and those who care for them, not technology

7. NPfIT Basic Structure The design and roll-out of the NHS Care Records Service has been organised into two parts: • Services that are common to all users nationally will be the responsibility of the National Application Service Provider (NASP). • Services delivered at a more local level will be the responsibility of five Local Service Providers (LSPs).

8. LSP Clusters

9. Phase 1 - by end 2004 • Booking of outpatient appointments online • NHS email and access to online knowledge • Electronic laboratory and radiology results • Some clinical communications e.g. GP referral letters • Basic “spine” functionality Providing simple functionality and making best use of existing systems

10. Phase 2 - by end 2006 • Access to a more detailed patient record including: • specialist results • GP prescribing record • hospital discharge summaries • Digital imaging • Computerised referrals and requests Migrating on to active and interactive functionality

11. Phase 3 - by end 2008 and continuing • Working towards full integration of health and social services including: • decision support software • screening • community wide prescribing • computer support for care planning • Supporting advanced features e.g. telemedicine Continuing development and enhancements

12. The Care Record Service • A mix of local and national IT services proving a cradle-to-grave NHS Care Record. • Summary patient record; personal health information and demographic data • “The Spine”

13. The Care Record Service • Applications at a local level provided by Local service Providers (LSP) • Accenture (£930 million) • Common national applications provided by National Application Service Providers (NASP) • BT (£620 million)

14. The Care Record Service • The NASP will provide software and support for summary patient record, and implement consistent security and confidentiality principles. • A Transaction Messaging System (TMS) and an Access Control Service (ACS)

15. The Care Record Service • The Local Service Provider (Accenture) will act as system integrators, supplier managers and programme managers for the clusters • They will ensure systems are spine-compliant and deliver hardware and software replacements and implement core local training

16. Got it? If not, just remember… The Care Record Service is a really, really GOOD IDEA.

17. E-Booking (oh no!) • Choice is a main driver behind eBooking • Patients will choose from a number of options including which hospital, and when, they would like to attend • Booking will be made at point of referral OR • Later on through a Booking Management Service (BMS)

18. E-Booking • Contract with Atos Origin • First bookings this year, then six phases • All surgeries by Dec 2005

20. Three Other Things… • Electronic Transfer of Prescriptions • N3 – bigger, faster, better • NHSmail – a lifelong secure email address for all NHS staff. So email me at phil.griffin@nhs.net

21. The Bluffers Guide to the National Programme • Know the 4 areas – NHSCRS, eTP, e-Booking, Infrastructure • “NPfIT” = “En Pee fit” • Remember the small “f” or lose all street cred • Practice saying “LSP clusters” and remember “East Midlands and East of England”. (Forget the rest) • Mug up on Accenture • Express enormous sympathy to any Celtic friends • Ask you colleagues if their systems are “spine-compliant” • Say “NHS Care Record Service” a lot, especially in meetings • Let as many people as possible know you’ve got an NHSmail address and actually use it

22. What does this mean for General Practice? • the LSP: • Phased introduction of “new solution” over few years • Spine compliant • Central servers • Info across N3 • Data exchange with acute trust/community clinics etc; support SAP

23. What does this mean for General Practice? • Choice of solution between two (nGMS says three) • Second TBA by October • In theory no compulsion to change. BUT…… • Contract also states “no loss of functionality” • BMA Guidance

24. So What’s Going On Locally? • The SHA has control • The Chief Information Officer is therefore a Very Important Person (Mike O’Brien) • The LIS Project – evolved and perished • ISSGs (4 quadrants + 1 SHA) • The Herts Health Informatics Service (HHIS) is expanding and evolving • June Dodds is our Project Manager • No GPs want to join in yet

25. Even More Locally… • We have 14 Practices: • 9 EMIS • 3 IPS • 1 Torex • Some are paperless • We have numerous scattered community sites, some poorly connected • NSF-driven PCT initiatives especially CHD • All main GP surgeries are on the NHSNet • All have pathology messaging • We have an IM&T manager and a Data Quality Facilitator (Assorted Roz/s’s) • Our PCT IM&T Strategy is done • Our Data Quality Strategy is done • Our IM&T Committee meets regularly and with Hertsmere • We have strong links with the SHA ISSG • We have implemented Network Managed Services

26. What Have We Got To Do? • Increase funding earmarked for IM&T • Get the Community staff and branch surgeries connected • PCT ownership and full funding of Primary Care IM&T • Convergence of Primary Care data quality • PCT-wide standard auditing • Move away from practice-based servers • Evolution towards the Care Record Service in co-operation with our LSP • Development and enhancement of support and maintenance

27. OK – HOW??? • Invest • PCT-wide standards in Information Governance • Work with the HHIS on the community and branch surgery networking • Expand Network Managed Services to all PCT practices, along with other PCTs • MSD Audit Tool • Data Quality Strategy • Training • Understand the New GMS Contract

28. A Vision of the Future… • Money. Lots and lots of money • A true broadband NHSnet infrastructure • Standardised medical record coding across the NHS • All clinicians have access to the information they need to know • Practices free to use whichever front-end they like, from a nationally approved list • Standardised note summarisation • Patient record held in Primary Care and on the “Spine” • Messaging in from secondary care • GP to GP transfer seamless and 100% via the “Spine” • Web-based access to medical records for patients and health professionals • Many web-based services for patients • GPs able to web-access secondary care databases and vice versa • E-everything – booking, prescribing etc.

29. Will It Work? • There is a real need • There is real central strong drive • There is available funding • The benefits are almost incalculable • There’s political will, possibly motivated by… • …a General Election

30. Director General of NHS IT, Richard Granger said:"Patients will see a modern, IT-enabled NHS, every time they come into contact with the service. They will benefit from coordinated,convenient and integrated care that places them at the heart of the NHS.”

31. For Coalface Clinicians • Proceed to “paperless” record keeping • Use the new GMS Q&OF to improve your coding • Consistent data recording across the practice • Information Governance

32. Information Governance • How does the practice handle, share and secure confidential information? • Caldicott Guardian • Written protocols • Staff training • Audit and review • Use the toolkit…