Integrated Electronic Clinical Records Services in England
Robin Mann1, John Williams1, Stephen Grainger2, Charles West3, Sally Greenway4, Heather
Heathfield5
1
Royal College of Physicians
2
British Society of Gastroenterology
3
NHS Information Authority.
4
Welsh Assembly Government
5
IT Perspectives Ltd
Background
The English NHS National Programme for IT (NPfIT) has developed a specification for
Integrated Care Records Services (ICRS). This describes the high level functional requirements
for a range of IT services. The ICRS specification is being used in the procurement process.
The draft specification for the ICRS was published as a consultation draft in July 2002. The first
version of the ICRS output-based specification became available earlier this year and can be
downloaded from http://www.doh.gov.uk/ipu/programme/index.htm. The Welsh Assembly
Government (WAG) has published ‘Informing Healthcare’ that sets out the strategic objective
of a single integrated electronic health record (SIEHR) in Wales.
Aims and objectives
The ICRS specification has been assembled by a group of experts within the English NHS
Information Authority and the National Programme for IT. There was agreement that it would
be valuable to have more wide-ranging and systematic front line clinical input in this process.
WAG wished to identify clinical and IT requirements of the SIEHR and issues to be addressed
in the exchange of information with the ICRS.
Therefore the Royal College of Physicians, British Society of Gastroenterology, NHS
Information Authority and Welsh Assembly Government commissioned a project that aimed to
develop a comprehensive statement of generic requirements from the clinical perspective, to
assess the ICRS specification’s coverage of those requirements and to produce a snapshot of
survey of the NHS’s current ability to meet the generic requirements in one service area.
Specific objectives were to:
•
Gather detailed requirements from practising clinicians.
•
Check these requirements against those defined in ICRS to identify any areas where
detail is missing.
•
Produce a detailed description of clinical information requirements (DCR) for clinical
systems.
•
Develop a generic checklist to survey current IT systems’ ability to meet these requirements.
•
Survey the current status in one service area and inform the procurement of new IT
systems.
The project is being undertaken by IT Perspectives Ltd and runs from June to the end of
November 2003. Details of the project and its outputs can be found at www.it-p.co.uk/icrs.
Methods
The project used the clinical requirements defined in the Academy of Colleges Information
Group (ACIG) generic ‘Specification of Core Requirements for Clinical Information Systems in
Support of Secondary Care’ (2001) as its starting point.
Production of the DCR involved the following steps:
1. Identification of the clinical requirements in the ICRS, through review by a clinician.
2. Mapping of the clinical requirements from ICRS to those in the ACIG specification.
This produced a detailed mapping of the links between both specifications.
3. Validation of the mapping to ensure all the requirements contained in the ACIG specification were contained within the ICRS.
The output from this process, the draft DCR, presents the clinical requirements of the ICRS
within the organisational framework provided by the ACIG specification. This was made
available for consultation via a website, email or post. Two consultation workshops were held
in Nottingham and Cardiff. The draft DCR was updated with additional requirements identified
through the consultation and workshops.
The DCR was used to develop a generic checklist of requirements for IT systems, which was
then used to survey the IT systems in gastroenterology (selected because care is provided across
organisational boundaries and are delivered by multi-disciplinary teams). The checklist has
been circulated to more than 300 clinicians who deliver gastroenterology services. The final
date for receipt of responses to the checklist survey was 17th November 2003.
Findings
This presentation will describe the process of developing the DCR and some of the key issues
arising. It will also present the results of the survey.