Integrated Care Records Service

Durham and Darlington

22 October 2002

National Programme Overview

Integrated Care Records Service -Phased portfolio includes clinical tools and functionality-National services -Local applications

Electronicappointmentbookings

Electronicprescriptions service

Partnership with IT Industry - deliver compliant systems & clinical applications - National, Regional, Local

National direction and performance management of ITNational standards and specification

Increase IT funding dramatically - target IT spend

Backbone IT infrastructure -accelerate connecting the NHS with

secure Broadband

Programme Overview

Achievements include:

• Published ICRS Standards and Specifications – 180+ replies

• Published outline Procurement Strategy – 80+ replies

• eBooking is at Full Business Case stage

• Ministerial Taskforce meets 22 October

• HR strategy for NHS Information Professionals – launch at conference end October

• Richard Granger, Director General, started on 7 October

Delivery

• Over 96% of NHS Consultants have desktop PC access to NHSnet

• eMail & Directory Services Contract signed 27 September

• eBooking Information Broker Service live 12 September (www.nhs.uk)

• Health Records Infrastructure pilot in Walsall from end October

• Establishment of CIOs in StHAs

Key Priorities….

• Provide central direction, local implementation, eg in PPF guidance

• Stakeholder inclusion, time to contribute

• Target increased funding

• Establishing standards

• Pragmatic implementation at high speed, while keeping the vision alive

Deliver better patient care.

Integrated Care Records Service

Phase 0 – Research

• ERDIP Demonstrators

• Patient Survey

• Supplier Relations

• International exemplars

• Exemplar sites

Critical elements of the National Programme

• NationalRobust national infrastructure, withNational information servicesAn increasing number of national applications, andstandards supporting local users across health

communities

• Localgeneric functionsuser environmentspecific functionsclinical conditions

AnalyticalServices

NHS DirectCAS

PopulationRecord

ETP

nhs.uk

.

NeLH ReferenceFiles

e-commerce

NationalServices

3. Application Services

2. Information Services1. Infrastructure ServicesNetwork

Security AccessControl

DirectoryE-mail

e-StaffRecord

Finance

National Services

e-learning

ICRS - Overview

The ICRS is the :

• Integrated, operating across the care continuum

• Care, covering both health and social care

• Records, single record based around the patient

• Service, with corresponding service levels

What is the purpose of ICRS ?

The purpose of ICRS is to support the provision of high quality patient care across the whole health community

LocalServices

NationalServices

Standards

Across Health Communities

InformationGovernance

Analysis

InformationReporting

InformationCapture

5. UserEnvironment

User Tools

Health Community AHealth Community B Health Community C...

Pat

holo

gy

Men

tal H

ealth

Acu

te C

are

Soc

ial C

are

Prim

ary

/ C

omm

unity

6. Specific Functions

Service User IndexDiagnosis and Care

Booking and SchedulingOrdering and Reporting

Prescribing

Clinical Governance4. Generic Functions

Digital ImagingKnowledge Management

CHD

Older People

Mental Health

Diabetes

Cancer

7. NSFs

AnalyticalServices

NHS DirectCAS

PopulationRecord

ETP

Nhs.uk

.

NeLH ReferenceFiles

e-commerce

3. Application Services

2. Information Services1. Infrastructure Services

Network SecurityAccessControl

DirectoryE-mail

e-StaffRecord

FinanceFinance

Etc.

e-learning

Phase 1 – Consultation

• Output Specification for ICRS

• Procurement Synopsis

• CIO Preparation

• Work with exemplar sites

• Industry consultation

ICRS Consultation Exercise

• 186 responses (as at 27 September)

74 from the NHS

62 from suppliers

50 others

• Workshops

• Structured Walkthrough

ICRS Consultation – Main Issues

• Vision and description – need more on benefits

• Clarification of procurement and implementation plan

•Need to phase implementation

• Suggestions on functional requirements – eg NSFs

• Need for Design and Architecture

Phase 2 - Planning

• Project Definition

• Project Initiation

Project plan

Risk register

Dependencies within the programme

• National Business Case

• Procure Integrated Care Records Services in a way that:

• provides a coherent national, top-down approach that will be capable of delivering the targets in the National Programme

• is sensitive to local requirements, both in terms of business objectives and technical / system legacy.

Objectives for ICRS Procurement

Possible examples:•Basic connectivity•Access to knowledge•Access to patient demographics•Results reporting•Patient access•Access to clinical records

1 – access services

Phasing Issues

1 – access services 2 - specialist services

Possible examples:•Basic connectivity•Access to knowledge•Access to patient demographics•Results reporting•Patient access•Access to clinical records

Possible examples:•Ordering•Digital imaging•Prescribing / Dispensing•Knowledge Management•Resource management

Phasing Issues

1 – access services 2 - specialist services

3 - communication services

Possible examples:•Referrals•Discharge summaries•Clinical correspondence•Care assessment•Care plans•Shared clinical records•Clinical governance

Possible examples:•Basic connectivity•Access to knowledge•Access to patient demographics•Results reporting•Patient access•Access to clinical records

Possible examples:•Ordering•Digital imaging•Prescribing / Dispensing•Knowledge Management•Resource management

Phasing Issues

1 – access services 2 - specialist services

3 - communication services 4 - integrated services

Possible examples:•Rules-based decision support•Integrated care pathways•Multi-organisational scheduling•Telecare and telemonitoring

Possible examples:•Referrals•Discharge summaries•Clinical correspondence•Care assessment•Care plans•Shared clinical records•Clinical governance

Possible examples:•Basic connectivity•Access to knowledge•Access to patient demographics•Results reporting•Patient access•Access to clinical records

Possible examples:•Ordering•Digital imaging•Prescribing / Dispensing•Knowledge Management•Resource management

Phasing Issues

Objectives

1. To improve the experience of patients

2. To improve the quality of care

3. To enable effective access to clinical and administration information

4. To reduce the fragmentation of care

5. To improve health policy development and health research

Investment Objectives

1 – access services 2 - specialist services

3 - communication services 4 - integrated services

Outcomes for Patients

Patients are offered the opportunity to exercise choice over date, time and place of future encounters with care servicesPatients are reassured that the information that they provide at any healthcare encounter is kept secure Clinicians have access to information about the latest care knowledge and practice

Patients have access to evidence of the quality of care provided to them or by local providersPatients can be confident that results and information are provided

Patients are able to use a range of technologies – PC’s, phones, digital TV – to interact with care services and at times that are convenient to them

Patients are able to understand their care process through use of “patient-friendly care pathway views”Patients are able to look at their records and have the ability to amend or add information (taking into account the legal implications)

1 – access services 2 - specialist services

3 - communication services 4 - integrated services

Outcomes for Clinicians

Clinicians have access to clinical information for their patientsClinicians have ready access to knowledge and learning materials

Clinicians are able to initiate service requestsClinicians will see support for specialist areas such as digital imaging and prescribingClinicians are able to participate in lifelong learning through access to education, training and development services

Clinicians have ready access to the knowledge, clinical tools and related services they need to support their clinical decision making processClinicians and managers are able to use high quality information in support of the implementation of clinical governance and improvement of public health

Clinicians have ready access to information about their patients when they want it, from wherever they want it (including peripatetic staff), and structured in a format they wantClinicians are assured that their records and communications with patients and colleagues are secure and conformant with agreed information sharing protocols

Current National Tasks

• Contract Structure

• Payment and performance mechanism

• Definition of implementation planning and approach to benefits realisation

• Definition of Design Authority

• Definition of architecture for ICRS within overall architecture

• Baseline Review in each StHA

• Agreement on local business cases

• Approval of National Business Case

• OJEC

Local Activities

• Baseline review (the “warranted” environment)

• Funding

• Systems

• Plans

• Develop local plans for ICRS

• Linked to Local Delivery Plans

• Migration strategy for ICRS

• Local selection process

• Business case

• Selection criteria

Local Activities

Any Questions ?Any Questions ?