Electronic Health Records in the United Kingdom of Great Britain & Northern Ireland

1. Electronic Health Records in the United Kingdom of Great Britain & Northern Ireland Lorraine Nicholson MIHM, MRSH, FHRIM, President of IFHRO, Chief Executive IHRIM, Independent Health Records Consultant EHR Conference, Amsterdam 12th June 2008

2. The United Kingdom of Great Britain & Northern Ireland • The UK is made up of the two countries of England and Scotland, the principality of Wales and the province of Northern Ireland. • Total Population is 59.6 million people:  ·         - England 49,805,700 (83.7% of total) ·         - Scotland 5,057,400 (8.5% of total) ·         - Wales 2,938,000 (4.9% of total) ·         - Northern Ireland 1,702,600 (2.9% of total) • Each country has a National Health Service (NHS) and in Northern Ireland there is integrated health and social care. • Each of the four countries has it’s own approach to the development and implementation of Electronic Health Records. EHR Conference, Amsterdam 12th June 2008

3. National EHR’s in England (1) • NHS Care Records Service (NHS CRS), - key component of the National Programme for Information Technology (NPfIT), a £6.2 billion programme, which supports the delivery of the NHS Plan. • …"the world's biggest civil information technology programme". • An individual electronic NHS Care Recordevery NHS patient in England by 2010 (2 years behind schedule) • Parliamentary Inquiry in 2007 -estimates of the total cost of NpfIT ranged from £6.2 billion to £20 billion at the time of the inquiry. EHR Conference, Amsterdam 12th June 2008

4. National EHR’s in England (2) • NHS Number is fundamental to the NPfIT & NHS CRS • A national unique patient identifier (10 digit number) to enable sharing of patient information across the whole of the NHS in England safely, efficiently and accurately • The Personal Demographics Serviceis the central, single source for patient demographic information in England • The Personal Spine Information Service (PSIS) is the central database containing clinical records for each NHS patient. EHR Conference, Amsterdam 12th June 2008

5. National EHR’s in England (3) • NHS Care Records Service will provide all 50 million NHS patients with an individual electronic NHS Care Record • For the first time in the 60 year history of the NHS, information about patients will be mobile, as patients ar • will connect more than 30,000 GPs and 270 acute, community and mental health NHS trusts in a single, secure national system • two elements to the NHS CRS: Detailed Records (held locally) and the Summary Care Record (held nationally). EHR Conference, Amsterdam 12th June 2008

6. National EHR’s in England (4) • The NHS CRS will enable each person's detailed records to be securely shared between different parts of the local NHS e.g. GP surgery and hospital. • Patients will also be able to have a summary of their important health information, known as their Summary Care Record, available to authorised NHS staff treating them anywhere in the NHS in England. • Patients will also be able to access their Summary Care Record using the secure website “HealthSpace”. EHR Conference, Amsterdam 12th June 2008

7. National EHR’s in Wales (1) • The NHS in Wales is large and complex • Over 10 million face-to-face healthcare events per annum • Care delivered by a wide range of national, local, statutory, contractor and voluntary organisations • High levels of deprivation, an increasingly elderly population and poor lifestyle • Has an annual budget of approximately £3.1 billion • Wales needs a modern healthcare system with services integrated around the patient. EHR Conference, Amsterdam 12th June 2008

8. National EHR’s in Wales (2) • Informing Healthcare (IHC) is a Welsh Assembly Government programme set up to improve health services in Wales by introducing new ways of accessing, using and storing information • IHC is working with NHS medical staff and consulting with the public to develop a national electronic health record; the “Individual Health Record” (IHR) • Secure web page - “My Health Online” to view medical history, order prescriptions, book appointments EHR Conference, Amsterdam 12th June 2008

9. National EHR’s in Wales (3) • NHS in Wales cannot achieve a single universal care record immediately - therefore adopted a flexible incremental strategy EHR Conference, Amsterdam 12th June 2008

10. National EHR’s in Wales (4) • Wales shares demographic services with England • NHS number is the unique identifier to provide a unique patient identifier for the Individual Health Record • Phased migration of all demographic systems to replacement systems provided by England's new Personal Spine Information Service (PSIS), which is part of the NHS Care Records Service (NHS CRS) • Negotiating with the NPfIT in England to use selected services including allocation of NHS numbers EHR Conference, Amsterdam 12th June 2008

11. National EHR’s in Scotland (1) • Modernisation strategy “Delivering for Health” focuses on the EHR as a core feature in delivering pro-active care to the population of Scotland • Health Information System built around the EHR will facilitate a shift from the current care model to “anticipatory, preventative and continuous care”. EHR Conference, Amsterdam 12th June 2008

12. National EHR’s in Scotland (2) • The Community Health Index (CHI) is a population register used in Scotland for health care purposes • The CHI number uniquely identifies a person on the index - Scottish equivalent of the NHS number in England and Wales • The CHI number is the unique patient identifier throughout the NHS in Scotland EHR Conference, Amsterdam 12th June 2008

13. National EHR’s in Scotland (3) • Scotland and Northern Ireland have recently issued a joint tender to purchase a patient management system, with rich clinical functionality, worth between £30-120m over four years • Possible pilot sites - NHS Ayrshire and Arran, NHS Borders, NHS Greater Glasgow and Clyde, NHS Grampian and NHS Lanarkshire (all Scottish health boards) • After piloting system will be made available to all health service organisations in Scotland and health and social services organisations in Northern Ireland EHR Conference, Amsterdam 12th June 2008

14. National EHR’s in Northern Ireland • Joint tender with Scotland • Population of 1.8 million people • Integrated Health and Social Services • Unique, very manageable and compact centralised organisation • Single Health and Care Number (equivalent of the NHS Number) to provide a unique identifier for national Electronic Health Records EHR Conference, Amsterdam 12th June 2008

15. In Summary… • All four home countries are working actively towards national EHR’s • Each country has it’s own approach to development and implementation • All are using a unique identifier for each patient • The next four years will see considerable changes nationwide in the UK EHR Conference, Amsterdam 12th June 2008

16. Questions? EHR Conference, Amsterdam 12th June 2008

17. Contact Details Lorraine Nicholson l.nicholson@zen.co.uk Tel & Fax: 01706 355957 Mobile: 07788 405910 EHR Conference, Amsterdam 12th June 2008