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https://nww.stuff.nhs.uk

https://nww.stuff.nhs.uk. Or Whither NHS net. Why?. Long personal involvement Central to all the changes that surround us Knowledge is power Pretending it isn’t going to affect us is not an option. Why?. Not for coding clerks. Who don’t have a long term future.

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https://nww.stuff.nhs.uk

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  1. https://nww.stuff.nhs.uk Or Whither NHS net

  2. Why? • Long personal involvement • Central to all the changes that surround us • Knowledge is power • Pretending it isn’t going to affect us is not an option

  3. Why? • Not for coding clerks. • Who don’t have a long term future. • Not just for the IT department. • For us all, clinical workers and management workers alike.

  4. What? • The NHS plan. • Information for health. • 1998 • Our LIS. • Our local funding. • Building the information core. • Jan 2001. • Other bits from all over.

  5. Strands in All This • Communications • Records • Information

  6. Strands in All This • Maybe money?

  7. New Ways of Working • Not bolting computers onto existing practices • About redesigning work • Redesigning care • New pathways in the jargon

  8. Secondary care Clinical and support staff; 25% have desktop access by now Really is 20% ‘ish 100% by 2002 Primary care GPs and managers 95% practices connected by now Really is 80% ‘ish 90% desktop access by now Really 50% ‘ish All 100% by 2002 NET Targets But but but but but !

  9. Email Net browsing Information source Fax out (doesn’t work!) NSTS (not that reliable!) Reading the stuff the NHSe no longer publishes – cures insomnia. National address book? GP registration links. GP IOS links – for the brave. Uses Now

  10. Security • Lags behind • Caldicott • Awareness • Safe havens etc etc • National audit scheduled for Dec 2001 • To BS7799 • NHS cryptography • Roll out spring 2002 • Public key encryption

  11. What Next? – Uses of NHS net • National priorities are pathology requests and reports. • Then xray reports and requests. • Booking. • Discharge information.

  12. Jargon EPR • Electronic Patient Record • ? Attainable EHR • Electronic health record • ? Holy grail

  13. Clinical Terminologies • Coding viz classifications • Read 3 • Ends 2003 • SNOMED – CT • Starts 2003 • ? Legacy coding and classifications

  14. EPR Level 3 • Integrated patient master index. • PAS. • Departmental systems (all departments) • Electronic clinical orders and results reporting. • Prescribing software. • Multi-professional care pathways.

  15. EPR – Primary Care • RFA99 legalises electronic records. • RFA99 roughly equates with levels 4-5 of secondary care EPRs. • Big problem is hospital letters. • ? Scanning. • ? EDI. ? 90% of practices by 2003

  16. EPR – Primary Care • Integrated nursing and medical EPRs are coming. • National framework expected in Sept 2001. • End of many Korner MDS expected in next month or two. • Local initiatives already underway.

  17. EPR – Out of Hours • National programme • To make summaries of GP EPRs available 24 hours a day • First to GP out of hours services • Then to A+E departments • ?? 2005

  18. EPR – Mental Health • Separate plans for mental health EPR. • Separate funding stream. • Integrated social and health records. • Shared with social services. • 25% by 2003 ? • Locally ahead of the game.

  19. EPR – Acute Hospitals • Weird set of levels defined by the NHS • 35% of acute trusts to have a level 3 EPR by 2002 • 100% by 2005 • Plenty of words and management speak out here – few systems!

  20. Local Status • 9 practices have full desktop NHS net connection. • All practices should be connected by end of year. • 16 practices have new LANs. • 6 practices “paperless.” • 5 practices going “paperless.”

  21. Local Status • FHN has connection. • FHN has too poor a LAN for full desktop access. • We have started a project for pathology reporting and requesting. • We hope to add in radiology soon. • Networking information sources is proceeding.

  22. Information • NICE • NeLH • Protocols • Policies • Guidelines • HiMPs • CHiMPs And uncle tom cobbly….

  23. Payroll and HR • A national payroll and HR system is planned to start rolling out in 2004. • Doing away with individual organisational arrangements.

  24. Caveats • Knowing that nurses share the same records and can rapidly communicate with doctors will allow more task sharing, profoundly changing the nature of medical work.

  25. Caveats • A lush information landscape where information is shared with patients leaves some things unknown: • If 1% of patients join the worried well? • Sharing all records with patients?

  26. Caveats • How much extra time to spend capturing and structuring records?[1] – 30 minutes plus per day. • [1] Tierney et al JAMA 1993;269:379-83.

  27. Caveats • Are we ready to share our information with patients ? • The strategy says there are irresistible arguments for this.

  28. Caveats • Control • Governance • Accreditation (and Re- ) • Performance related pay • Politics Or just my depixol dose is late.

  29. A Personal Hope Clinical Needs Not Technology for its own sake

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