what the nhs care records service will mean for primary care
DESCRIPTION
What the NHS Care Records Service will mean for Primary Care. Paul Charnley and Dr Mike Bainbridge. What the NHS Care Records Service will mean for Primary Care. Paul Charnley Regional Implementation Director North West and West Midlands Cluster. Overview of Presentation. - PowerPoint PPT PresentationTRANSCRIPT
PRIMIS Partnerships For Progress March 2004
What the NHS Care Records Service will mean for Primary Care
Paul Charnley and Dr Mike Bainbridge
What the NHS Care Records Service will mean for Primary Care
Paul Charnley
Regional Implementation Director
North West and West Midlands Cluster
Overview of Presentation
NPfIT – Overview of the Programme
NHS CRS and Primary Care – Current thoughts from a Cluster
Practical Issues – the benefits in prospect and implementation issues that face us.
• Confidentiality and Security• Data quality • eBooking• Electronic Transfer of Prescriptions• Electronic requests and results• Change to patient centric records –
access and choice• Secondary uses - New GP Contract
Who is doing what?
NPfIT - Overall NHS project development and management on behalf of the DoH
NHS CRS Programme – Development of the Service and specialist input into NPfIT
Clusters – ‘Localised’ NHS implementation management within each of the 5 locations for all NPfIT programmes
NASP – Contractor: ‘BT’ – Delivering the National Aspects of the NHS Data ‘Spine’
LSP’s – Contracts awarded – Deliver the products to support the services within a cluster
Local IM&T – Including local CIO’s – support delivery directly to services, liaison between LSP’s and workforce
Will enable details of the key events of a persons healthcare history throughout their life to be;
● collected, stored & retrieved● made available at all times ● across the whole country ● to those with authority to view
A better use of information and communication technology within the
NHS would improve efficiency and cut costs
Wanless Report April 2002
Introduction – The NHS Care Record
NASP contract awarded to BT
Responsible for delivering nationwide aspects of NHS Care Record Service;
● NHS CRS Data Spine
● Secondary Uses Data warehouse
Main Data Spine components
● Transaction Messaging Service (TMS) - Manages messages in / out
● Personal Spine Information Service (PSIS) – Holds all clinical messages
● Personal Demographic Service (PDS) – Information for patient identification
NASP (National Application Service Provider)
Data
Messages
Processes/Logic
Applications
Other Links
Infrastructure/Services
Personal Demographic Service
Business continuity
and DR
Access and Control
Help Desk
Patients
Personal Spine Information Service
Spine Directory Service
Help Desk NHS
Transaction Messaging Service
Patient Details
eBooking
Clinical Messages
eTP
Patient Details
eBooking
Clinical Messages
eTP
Terminology Services
Workflow & Rules
Service
Links to ‘Health Space’
InterfacesLinks to Remote
Settings
Links to NationalServices
Clinical Applications
(View)
Secondary Uses Services
Replacement NWCS
Clinical Applications
(Input)
Data Quality &Data Quality
Management
NHS Care Record Spine – Components
The technical Infrastructure
LSP contracts awarded to
BT – London - IDX
Accenture – North East and East - iSoft
CSC – North West & West Midlands – iSoft
Fujitsu – South and South West - IDX
LSP (Local Service Provider)
Main Local NHS Care Record Service components (Core Bundles) (Different iSoft/IDX)
LSP (Local Service Provider)
1 Connectivity, Messaging and Access to PSIS and Spine Directory and eBooking Messaging
2 ICRS Set up and Basic Patient Administration within each Care Setting
3 Assessment & Clinical Documentation (including social care & elements of NSF's)
4 Clinical Support Services - Requesting & Order Communication, Decision Support and ePrescribing
5 Scheduling (including scheduling elements of NSF's)6 Integrated Care Pathways and Care Planning (including
elements of NSF's, e.g. CPA)
Main Local NHS Care Record Service components (Core Bundles) (Different iSoft/IDX)
LSP (Local Service Provider)
7 Maternity8 Information for Secondary purposes (including
elements of NSF's) 9 Emergency/Unscheduled Care10 Surgical Interventions11Alternative Options for GP's12 Prevention, screening, surveillance includes
elements of NSF's13 Ambulance
Main Local NHS Care Record Service components (Additional Bundles) (Different iSoft/IDX)
LSP (Local Service Provider)
• PACS and Medical Imaging• Radiology • Pathology• Financial Payments• eHealth• Document Management• Dental• Pharmacy Stock Control• Prevention, screening, surveillance• Social Care• Decision Support Advanced• Long term medical conditions
Patient IndexPACS
Prescribing &Pharmacy
Scheduling
ClinicalDocumentation
Request & OrderCommunication
Decision Support
Assessment
ResultsReporting
DocumentManagement
eBooking
Care Management
Care Pathways & Planning
User Tools
Prevention, scheduling
& surveillance
eBookingElectronic Transfer
Of Prescriptions
Personal Spine Information
Service(PSIS)
Personal Demographic
Service(PDS)
Transaction Messaging Service(TMS)
NASP
LSP
Service Components
Phasing - Overview
A phased delivery is necessary to;
● Meet NHS targets
NSF targets, e.g. SAP
● Facilitate delivery of a reliable stable national architecture
● Manage affordability
● Support an achievable delivery across the country
● Phase 1 Release 1 - June 2004 Release 2 – Dec 2004
● Phase 2 Release 1 - June 2005 Release 2 - June 2006
● Phase 3
December 2010
Phasing
Phase 1– Access to information– Passive, viewing of data– Implementation of specific
targets
Phases 2 and 3– Active support for care
provision– Order communications,
prescribing, scheduling– Full functionality
Technical Infrastructure – Expected Take-up
Total number of messages annually through Transaction Messaging Service
0
1,000,000,000
2,000,000,000
3,000,000,000
4,000,000,000
5,000,000,000
6,000,000,000
2004 2005 2006 2007 2008 2009 2010
Year
No
. o
f M
es
sa
ge
s
PMIP
Ebooking
ICRS
ETP
PMIP
EBS
NHS CRS
ETP
NASP
LSP
iSoft i.EPR / Lorenzo
SeeBeyond Integration Bus
EM
IS P
CS
Torex P
SE
InPractise V
ision
Niche
Cluster wide Data Repository
Portal
Solution Architecture
eBooking PDS PSIS eTP
Transaction Messaging Service
Wrapper
Local NCRS
Messages
Messages
eBooking PDS
PSIS eTP
Primary Care - Evolution and Choice
PrimaryCare
System
Practice
Local NCRS
Wrapper
PrimaryCare
System
Data Centre
Other LSP
Services
Local NCRS Local NCRS
Integrated Services
eBooking PDS
PSIS eTP
Migration and Choice
Lorenzo
? ? ?
Current SituationMultiple Practice Systems with a few bureaux
04-06Tactical Hosted Bureaux ServiceMessaging compliantNot all system types supportedNot all practices migrated
?
06 onwards - Strategic position Primary Care Solution part of the Integrated NHS Care Record Service
?
Impact on Primary Care
Primary Care has a rich history of successful electronic patient records development and use
● Standards (RFA)
● Registrations (IOS)
● Appointments
● Longitudinal record
● Support for prescribing
● Audit and NSFs
… more
Issues for Primary Care
● Records in Practice only
● Wider primary care may or may not have access
● Links to the rest of NHSResults Requests/Referrals Prescriptions
● New models of care – Tier2/ Intermediate/ GP with Special Interest
● Out of hours/ unscheduled care
● NHSNet constraints… more
● Confidentiality and Security
● Data quality
● eBooking
● Electronic Transfer of Prescriptions
● Electronic requests and results
● Change to patient centric records –access and choice
● Secondary uses - New GP Contract
Issues/Implementation
Information Governance 12 principal topics
• ICRS Data Sharing
• Patient Access
• Legitimate Relationships
• Sealed Envelopes
• Role Based Access Control
• Other Access Controls
• Audit Trails
• User Registration• User Authentication• Pseudonymisation
Service• Secure
Communications• Compliance
Information Governance
A balance of benefits versus risks
● Protecting patients’ concerns without imposing impossible burdens on care delivery
● Caldicott Guardian principles will govern all data usage
● Plans in-hand for healthcare information governance service
Security
● Password / smart-card protection
● Audit trail for all ‘transactions’ – traces computer, user, activities performed / data accessed
0203_01:32 Patient W. Nurse A – New Record
0203_01:32 Patient C. Nurse F – Medication
0203_01:33 Patient X. Doctor C – Test Result
0203_01:33 Patient X. Doctor C – Clinical Note
0203_01:33 Patient A. Patient A - Discharge
… more
0203_01:32 Patient W. Nurse A – New Record
0203_01:32 Patient C. Nurse F – Medication
0203_01:33 Patient X. Doctor C – Test Result
0203_01:33 Patient X. Doctor C – Clinical Note
0203_01:33 Patient A. Patient A - Discharge
Information Governance
Confidentiality
● Rigorous role-based access controls
● Patient choice - electronic sealed envelope for highly sensitive information (expected during Phase 2)
● Professional & employee codes of conduct to govern usage
Information sharing
● Based on protocols & legitimate care relationships
● Patients able to ‘opt-out’ of consent to share information externally (i.e. Social Services)
Data Quality
● Good work done by PRIMIS in this area
● Ensure data is “Fit” for purpose
● To build record gradually or complete it with “downloads”?
● Patient registers
● Summarized records
● Extending content e.g. additional members of the primary care team
● Use of NHS Number
eBooking
● For the benefits of patients
● Shift of tasks around the health communities
● First high profile implementation
● Starts small with early adopters and grows
● Longer term plans
● Within PCTs
● Integrated with scheduling and Integrated care pathways
0203_01:32 Patient W. Nurse A – New Record
0203_01:32 Patient C. Nurse F – Medication
0203_01:33 Patient X. Doctor C – Test Result
0203_01:33 Patient X. Doctor C – Clinical Note
0203_01:33 Patient A. Patient A - Discharge
Electronic Transfer of Prescriptions
● Underway but awaiting details of the new pharmacist contract
● Current manual process duplicates, introduces errors
● Repeat prescriptions
● Physical “token”
Electronic requests and results
● Efficiency and safety
● Reducing duplication
● Pathology results started will be included
● Other results scheduled for P1R2
● Requests – guidance and protocols
● Less error in processing the requests
Change to patient centric records –access and choice
Health economy
Care settings
Healthcare services
National Scope
Clusters
SHA
Local Health Community
Organisation
Secondary uses – e.g New GP Contract
Pseudonomysed data set for analysis
Clinical Network
Supporting Implementation
Your support is vital to make this happen –
You have the opportunity to;
● Be involved in a process that will truly modernise the NHS
● Make it happen successfully both locally and nationally
● Enhance the position of informatics as a profession
● Support the development of a unique clinical infrastructure
● Support the delivery of a service that will have real benefits for patient care
