A game of two halves… …and two personalities

1. A game of two halves… …and two personalities Health Informatics Review Brian Derry, NHS CFH 2. The Independent Review of NHS IT Brian Derry, ASSIST Chair

2. The Health Informatics Review - from words to deeds ASSIST North West 30 October 2008 Brian Derry brian.derry@nhs.net

3. Summary • Background to the Health Informatics Review • Health Informatics Review: • Strategy • Commitments • Next steps and conclusions

4. Background to HIR • Commissioned by NHS Chief Executive & DH Permanent Secretary in September 2007 • Over 1,400 stakeholders consulted: • 1,000+ frontline NHS staff • public opinion researched, through a deliberative event, online questionnaire and survey • voluntary organisations and professional bodies • SHA & NHS Chief Executive Officers and Chief Information Officers • Findings published as part of NHS Next Stage Review, on 10 July 2008

5. HIR scope Health Informatics Review Programme Project 1 Meeting the information needs of theDH and NHS Project 2 Maximising the benefits from NHS CRS & SUS Project 3 Creating aninformation system and management structure “NHS CRS and SUS” “Governance” “Information” To outline an information and IT architecture capable of supporting the world-class NHS envisaged in the NHS Next Stage Review

6. NHS Next Stage Review

7. High quality care for all: NHS Next Stage Review • Raising standards • Stronger involvement of clinicians in decision making at every level of the NHS • Fostering a pioneering NHS • Help to stay healthy • Empowering patients • Most effective treatments for all • Keeping patients as safe as possible • Quality at the heart of the NHS • High quality care for all • Empowering frontline staff to lead change that improves quality for patients • Valuing the work of NHS staff • High quality care for patients and the public • Freedom to focus on quality

8. Need for high quality information • People want information to: • understand choices about care, & how to stay healthy • be confident that health & social care staff have the information needed to provide care effectively and safely • Care professionals:when providing care, regardless of where the person was previously seen • Commissioners:plan & redesign services • Managers of health & social care services: • monitor & assure quality • make decisions based on evidence & best practice • account for their actions • Regulators: to assure NHS & independent sector care providers

9. HIR strategic implications

10. HIR key themes • Delivering better, safer care: person-based information for clinical & care processes, shared across organisational boundaries • Empowering staff to improve NHS performance: research, planning & management, improving quality of care & supporting regulatory activities • Empowering patients and the public: • making information available about health, services, & patients’ own health & wellbeing • providing patients with secure access to their own electronic records & increasing their involvement in shaping the NHS • Focusing on IT alone will not meet the needs of the NHS.

11. Patient information available at the point of need • Strategic solutions making patient/client information available securely across care settings • People will be able to: • access their own care record securely • have information to make informed choices about their own healthcare and wellbeing • Additional services available to patients on-line • Information should: • be collected once, as a by-product of care • be used many times - new data only when absolutely necessary • be improved through an integrated data quality programme. Strategic consequences

12. Responding to clinical priorities • Achieving the strategic vision: • Investigate interim solutions, including widening choice of LSP solutions • Trusts’ roadmaps by April 2009 describing how strategic vision will be achieved • Local solutions subject to convergence with LSP & national strategic direction, & to local funding & business cases • Early delivery of priority secondary care products (“clinical five”): • Patient Administration System (PAS) integrated with other systems & with sophisticated reporting • Order Communications and Diagnostics Reporting - all pathology & radiology tests and tests ordered in primary care • Letters with coding: discharge summaries, clinic and A&E letters • Scheduling: beds, tests, theatres • e-Prescribing, including ‘To Take Out’ (TTO) medicines • Fill information gaps: • clinical metrics • mental health; community and social care.

13. HIR commitments Information and Standards Systems and Benefits People and Skills Processes and Structures

14. Strand 1:Information & Standards

15. Information actions • Filling gaps: clinical metrics, community, mental health, social care • Data quality • Access and use: • Syndication & Signposting • Strategic reporting solution • Streamlining data collections

16. Information Standards • Fundamental review of the (1970s) NHS data model to create one suitable for a 21st century NHS • Short- term improvements • to meet immediate needs - community, mental health, private sector care & measures of clinical quality • reduce unnecessary bureaucracy • Scope of the NHS Care Records Service to cover independent & voluntary sector providers, & social care • Technology & standards to allow high quality local products to be integrated within hospitals; full integration of products across care settings & providers • Robust process to ensure widespread adoption of existing standards (e.g. NHS number, SNOMED)

17. Information Standards Programme -7 elements • Logical Health Record Architecture • logical structure for an Electronic Health Record • definitions for key clinical concepts & associated coding • Commissioning Data Sets Futures – community, children & maternity, long term conditions • Streamlining the end-to-end standards process • Social Care • Pathways Groups – maternity, long term conditions… • Metrics for measuring Care Outcomes • Analysis and Currencies – outputs & units of care activity

18. Strand 2:Systems and Benefits

19. Systems to support high quality care Delivering better, safer care Quality at the heart of the NHS NHS Care Records Service – Summary & detailed records Choose and Book PACS Electronic Prescription Service N3 Spine NHSMail Empowering patients and the public High quality care for patients and the public Empowering staff to improve NHS performance Freedom to focus on quality Secondary Uses Service Clinical Dashboards NHS Comparators Staff Gateway Research Capability Programme GP Extraction Service NHS Choices HealthSpace

20. Clinical dashboards Clinical team, ‘day-to-day efficiency’ dashboard Monthly ‘quality of care benchmarking’ dashboard Individual, ‘comparative clinician’ dashboard Allows clinicians to monitor and benchmark process effectiveness & outcomes against best practice. Focus on qualitative outcomes, e.g. patient experience, quality of care. Weekly/monthly updates. Allows clinicians to monitor individual metrics, compared with peers. ’Portfolio’ contributes to continued accreditation with professional bodies. Weekly/monthly updates. Locally defined dashboards: improve patient flow & treatment patterns; multi-disciplinary. Rapid updates (up to every 15 mins) • Indicators align to national/internationalbest practice & be integrated with national clinical protocols (e.g. designed by Royal Colleges)

21. Staff Gateway • Support NHS staff in delivering first class quality of care through education & training, & access to knowledge & information • NHS staff now have to access many different internal information & IT systems to do their jobs • Staff Gateway to provide: • ‘one-stop-shop’ for the key information sources • Professional portfolio: • single access point to development and knowledge • a space for storing information essential to appraisal, revalidation & clinical excellence awards • online log of personal activity & outcomes

22. HealthSpace • Empower patients & public • Already lets patients record information on their own health; also: • record preferences • record self-administered drugs & health monitoring • let patients see their own Summary Care Record

23. NHS Choices • Much more information, not just hospital care but also primary & community care • To be the reliable source of information to help patients understand their illnesses & stay healthy • In time, will include: • other services such as those provided by social care will be included. • new local and national clinical metrics and dashboards

24. Strand 3:People & Skills

25. Informatics-literate NHS Informatics-literate NHS Strong informatics governance Sound leadership Skilled staff Good processes Within DH & NHS Outside DH & NHS Standards governance Policy integration Investment assessment Informatics staff Other staff

26. Sound leadership • New CIO for Health – Christine Connelly - Board level post reporting directly to the NHS CEO • CIO has formal responsibility for providing professional leadership to the major informatics organisations inside and outside the Department of Health • Expectation that SHA, trust and PCT boards include a “credible, capable CIO able to contribute fully to strategic leadership and Board decisions” • National informatics leadership to: • develop the profession • co-ordinate the existing expertise • build the informatics capability of the general and management workforce

27. Good processes • Improved arrangements for early assessment of the central and local informatics implications of new policy – “Policy and Business Informatics Support” • Ensure that IM&T priority and funding is given to the most appropriate requirements • Mainstream IM&T planning - NHS Operating Framework, IM&T planning guidance

28. Skilled staff • Creation of a health informatics career framework, mapping to the wider NHS career framework, to guide development of staff who wish to progress • Health Service leadership to address skills needed in the NHS to deliver large scale IT-enabled change & to develop the Informatics Profession. • Informatics content - to agreed national standards - in core training & professional development programmes for NHS clinicians and managers • SHAs and NHS CFH to work with suppliers on supplier capability to help ensure that planned milestones are met & products are fit for purpose.

29. Developing the informatics workforce • Career pathways and development • Embed health informatics into NHS Careers Framework • Clearly define standardised pathways & criteria for advancement • Provide skills & training modules linked to each career level • Create options for different paths to support different individual skills & aspirations • Workforce development and planning • Encourage the development of a skilled talent pool with relevant qualifications, through partnership with educational institutions • Strengthen long term planning of Informatics workforce requirements, & expand recruitment sources • Confirm professional leadership arrangements

30. Developing the informatics workforce • Generate excitement around a rewarding Informatics career • Ensure management commitment to supporting Informatics staff • Strengthen competitive position of critical informatics roles • Local consideration of recruitment and retention premia, consistent with Agenda for Change • Attract and develop more individuals through the existing graduate training scheme • Develop informatics apprenticeship & talent management schemes • Attraction, motivation and retention • Performance management • Reinforce expectations & accountability for individual performance • Introduce strong performance feedback systems to promote personal growth • Develop mechanisms for providing assurance about informatics services, processes & people

31. Conclusions

32. Key messages - 1 • Information and IT are central to: • improving health and social care services • empowering service users and staff • Investment in IT allows a leap forwards in the scope, availability & use of information • Emphasis on information about the quality of care, for patients, the public and staff • Renewed focus on delivering systems now to meet clinical priorities

33. Key messages - 2 • New CIO for Health: • reporting to NHS CEO • on NHS Management Board • underlines importance of informatics & provides a model for the NHS • Recognition of the importance of informatics skills & new impetus to developing the informatics profession and workforce

34. Key messages - 3 • NHS Connecting for Health: • Centre of IT expertise for NHS, not just implementers of NPfIT • Embrace private & voluntary healthcare providers, & Social Care • Information Centre for health and social care: • Maximise the value of data collected • Improve data quality • Encourage data re-use through a ‘syndication service’, • Promote access through information signposting service • Encourage innovation in the information and data analysis markets • Be the source of data for DH, CQC and other official statistics.

35. HIR next steps • Specific action plans – business cases, procurement, implementation etc • Implementation by the autumn, aimed more at informatics specialists, with detailed update & plans • Continued stakeholder engagement • Embed as “business as usual”

36. Your questions?

37. Independent Health IT Policy Review Brian Derry Chair of ASSIST National Council

38. Remit of the Review • Establish how clinical, public, and management needs can most effectively be met by information technology • In the light of the developments and progress of the last few years, establish a vision for IT in the NHS, health and social care • Set out a strategy for achieving that vision including a workforce strategy • Advise on action for the current Government to take • Advise on the policy options to be considered for implementation by an incoming Conservative Government

39. The Review Group • Dr Glyn M Hayes - GP, BCS & UKCHIP • Gail Beer - Independent Consultant • Iain Carpenter, MD FRCP - Clinical Lead on Record Standards, Health Informatics Unit, Royal College of Physicians  • Ian Shepherd, MRPharmS, FBCS, CITP   • Professor John Williams, Director, Health Informatics Unit, Royal College of Physicians

40. Set questions - 1 • Strategy • What are the strategic objectives that can be supported through use of IT and information in health and social care? • Capture and use of clinical data for individual patient managementWhat are the advantages and disadvantages of using person-centred data captured in patient-focused records? • How should patient and service user outcomes best be measured? • What are the benefits and disbenefits of patient and service user recorded outcome measures? • Who should perform the necessary data capture, how should it be done, and how can accuracy be ensured? • What are the key issues with regard to data quality? • How important will it be to introduce professionally-agreed clinical standards for the data captured in patient records?

41. Set questions - 2 • Patients • How are those who are disadvantaged, have a disability or are not computer literate affected by the increased use of IT in the delivery of health and social care? • Management of the NHS, health and social care • How can the delivery of health and social care be better supported by IT? • How should data to support the management of health and social care be derived? • How could IT support commissioning in health and social care? • Health and Social Care • How could information be beneficially shared between health and social care? • Information Governance • What are the relevant issues and tradeoffs with regard to security, confidentiality and data governance?Who should have primary responsibility for the content of a shared record?

42. Set questions - 3 • The approach to system architecture • What is right balance between centralised and decentralised systems? • Should systems be designed and built to support specific diseases, interventions, professional disciplines or patients, regardless of their clinical problems? • What future technical developments could affect the use of IT in health and social care? • What role might other informatics models play (Google Health, MS Vault, open source etc)? • What role, responsibilities and structure might a national centralised IT support body have? • How can the system procurement process be optimised to maximise and sustain benefits?

43. Set questions - 4 • Evaluation • How should new and existing systems be evaluated? • Leadership and Human Resources • How can professional leadership be best developed and used to encourage the effective use of health and social care informatics and to support patient and service user care? • How can staff commitment be maximised at the local level? • How should the change process be managed?What education and training will health and social care staff need? • How are the workforce in health and social care affected by the increased use of IT?

44. ASSIST process • Workshop, 24 September: • 30 senior informaticians: NHS, CFH, IC, academia • Facilitated by John Farenden, Tribal Consulting, under MOU with ASSIST • Written contributions/comments • Report submitted 30 September • Publicity – e Health Insider, Computer Weekly, Public Servant

45. ASSIST themes -1 • Vision unchanged: detailed, person-centric, securely accessible electronic records across health & social care • Pervasive IT & public expectations: • NHS & banking • Building confidence – public & staff • Media negativity • “NHS supercomputer” • Blaming & schadenfreude

46. ASSIST themes -2 • Unifying concept – patient encounter • Standards rather than standardisation • Balancing local & national: • One size does not fit all • Responsibilities to wider community • Building confidence: • Openness & transparency • Building on success & learning from problems • Encouraging SME suppliers

47. ASSIST recommendations -1 • Get the basics resolved before trying the ambitious • Do not lose or threaten the hard won successes • Focus on (person-centred) standards • Achieve a balance between technology, systems, people, process and culture • Ensure much earlier and more integrated policy planning at both national and local levels

48. ASSIST recommendations -2 • Invest in a systematic health informatics R&D programme • Avoid structural change • Avoid stand-alone data demands • Avoid insular systems development • Invest in developing informatics skills, leadership and the profession

49. Questions to you • Is our broad analysis right? • Are our recommendations right? • What more can we all do to help advance the cause of informatics?