The Health Informatics Review from words to deeds
ASSIST London & the South East
17 November 2008
Brian Derry
brian.derry@ic.nhs.uk
ASSIST
Association for Informatics
Professionals in Health
and Social Care
Summary
• Background to the Health Informatics Review
• Health Informatics Review:
Strategy
Commitments
• Next steps and conclusions
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, 10
July 2008
HIR scope
Health Informatics Review Programme
Project 1
Meeting the
information needs
of the
DH and NHS
“Information”
Project 2
Project 3
Maximising the
benefits from
NHS CRS & SUS
Creating an
information system
and management
structure
“NHS CRS and
SUS”
“Governance”
To outline an information and IT architecture capable of supporting
the world-class NHS envisaged in the NHS Next Stage Review
NHS Next Stage Review
High quality care for all:
NHS Next Stage Review
Raising standards
Help to stay healthy
Empowering patients
Quality at the
heart of the NHS
Most effective
treatments for all
Stronger involvement of clinicians in
decision making at every level of
the NHS
Fostering a pioneering NHS
Keeping patients as
safe as possible
High quality care for
all
High quality
care for patients
and the public
Freedom to
focus on quality
Empowering frontline
staff to lead change
that improves
quality for patients
Valuing the work of
NHS staff
Patients
Success is getting from:
• Patient records held on paper, hard for the
•
patient to access or understand
Choice poorly understood and limited
information available to support patients
Public
• Disparate sources of information to inform
•
the public about health and wellbeing with
little control of validity
Perception that NHS is not delivering value
for money
• Variable access to up to date, timely and
Staff
•
•
accurate clinical information causing
errors and cancellations
Management decisions often based on
inaccurate operational and performance
data, or no data at all
Few systems to provide staff with access
to targeted information to help them do
their jobs or personalised information on
their development and learning
…to:
• I have access to my record
• I understand what is going to happen to
•
•
me and my options
I can make informed choices to receive the
best possible care
I can be involved in my own care
• I know where to find trusted answers on
•
•
health and wellness
I can see how my local health services are
performing
I can see information about the quality of
services provided
• Single source of patient & clinical
•
•
•
information available at the point of care
Electronic records will reduce the burden,
help to join-up treatment along care
pathways, & lead to improved patient care
Clinical performance indicators available
for individuals, managers & organisations
to improve patient care
Staff have access to relevant information &
an employment, knowledge & learning
support system
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
Strategic Implications
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.
Strategic consequences
•
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.
Clinical priorities
Achieving the strategic vision:
• Investigate interim solutions & widening choice of LSP solutions
• Local solutions subject to convergence with LSP & national strategic
direction, & to local funding & business cases
Early delivery of priority secondary care products (“clinical five”):
• PAS integrated with other systems & with sophisticated reporting
• Order Communications and Diagnostics Reporting - all pathology &
radiology tests, & 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.
HIR commitments
1. Information and Standards
2. Systems and Benefits
3. Informatics-literate NHS
1. Information & Standards
Information Actions
• Filling gaps:
clinical metrics
Community
Mental health
Social care
• Streamlining data collections
• Data quality
• Access and use:
Syndication & Signposting
Strategic reporting solution
Clinical metrics
Three broad workstreams:
1. Better use of existing data
2. Development of new measures
3. Patient Reported Outcome Measures (PROMS):
 Four elective procedures mandated from April 2009
 Data collected on day of admission and 3-6 months
later
 Data can be used by commissioners to hold providers
to account and to contract on the basis of relative
clinical quality as perceived by patients
5 dimensions: mobility,
self-care, usual activities,
pain/discomfort, &
PROMS
anxiety/depression.
Procedure
Condition-specific
Generic
Primary Unilateral Hip
Replacement
Oxford Hip Score
EQ5D
Primary Unilateral Knee
Replacement
Oxford Knee Score
EQ5D
Groin Hernia Repair
None
EQ5D
Varicose Vein Procedures
Aberdeen Varicose Vein
Questionnaire
EQ5D
Plus a standard set of
patient-specific questions
in all cases
Data Quality Programme
DQ Guild
Stakeholders
Organisation reps
Informatics professionals
DQ Touchstone
Comparator
Quality Indicators
Across datasets and
collections. Linked to
data catalogue.
Frontline DQ
Awareness and
education. Impact of
data quality on patients,
organisations and staff.
Basic DQ guidance
DQ Accreditation
DQ Lexicon
Organisational DQ
Signposts to
Standard framework.
existing tools and
Self assessment tools. good practice. Special
Formal audit. DQ
interest groups and
monitoring.
forums.
Stakeholders:
Regulators: Healthcare
Commission, Monitor, UK
Statistics Authority, NAO, NICE
Users: DH, Commissioners,
SHAs, PCTs, researchers
Data suppliers: SHAs, PCTs,
NHS BSA, care providers
Data quality mediators:
Clinical Back Office, National
Back Office, Local Back
Offices, SHAs, PCTs
System providers: CFH,
LSPs, system suppliers
Information Standards
• Fundamental review of (1970s) NHS data model to create one
suitable for 21st century NHS
• Short- term improvements
 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)
Data Standards
Programme -7 elements
1. Logical Health Record Architecture


logical structure for an Electronic Health Record
definitions for key clinical concepts & associated coding
2. Commissioning Data Sets Futures – community, children &
maternity, long term conditions
3. Streamlining the end-to-end standards process
4. Social Care
5. Pathways Groups – maternity, long term conditions…
6. Metrics for measuring Care Outcomes
7. Analysis and Currencies – outputs & units of care activity
2. Systems and Benefits
Systems supporting high quality care
NHS Care Records Service –
Summary & detailed records
Choose and Book
PACS
Electronic Prescription
Service
Empowering
patients and
the public
High quality
care for
patients and
the public
NHS Choices
HealthSpace
Delivering
better, safer
care
Quality at the
heart of the
NHS
N3
Spine
NHSMail
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
Clinical dashboards
Clinical team,
‘day-to-day
efficiency’
dashboard
Locally defined
dashboards: improve patient
flow & treatment patterns;
multi-disciplinary.
Rapid updates (up to every
15 mins)
Monthly
‘quality of care
benchmarking’
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.
Individual,
‘comparative
clinician’
dashboard
Allows clinicians to
monitor individual
metrics, compared with
peers. ’Portfolio’
contributes to continued
accreditation with
professional bodies.
Weekly/monthly
updates.
• Indicators align to national/international best practice & be integrated
with national clinical protocols (e.g. designed by Royal Colleges)
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
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
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
3. Informatics-literate NHS
Informatics-literate NHS
Informatics-literate NHS
Strong informatics governance
Sound
leadership
Within
DH &
NHS
Outside
DH &
NHS
Skilled staff
Good
processes
Standards
governance
Policy
integration
Investment
assessment
Informatics
staff
Other staff
Sound leadership
• New CIO for Health – Christine Connelly - Board level post reporting
directly to the NHS CEO
• CIO for Health formal responsibility for 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
Skilled staff
• Health Service leadership to address
skills needed to deliver large scale IT-enabled
change
development of the Informatics Profession
• Informatics content in core training & professional
development for NHS clinicians and managers
• Local informatics leadership, prioritisation &
delivery, with central support & resources
• Informatics career pathways
• Apprenticeship, graduate training & talent
management schemes.
Priorities - informatics specialism
•
•
•
•
•
•
Visible professional leadership - centrally & SHA CIOs
Promote CIOs on NHS Boards - CIO for Health model
Accreditation of informatics services, processes & people
Initial focus on IT, IM & PPM
Encourage registration with UKCHIP
Subsidiarity - strong local focus for governance,
prioritisation and delivery, supported nationally
• Access to additional skilled resources to support local
implementations, e.g. central support teams, national calloff contract.
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
•
Develop accreditation of HI services – function of
products, processes & people
Conclusions
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
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
Key messages - 3
• NHS Connecting for Health:
 Centre of IT expertise for NHS, not just NPfIT
 Embrace private & voluntary healthcare providers, & Social
Care
• Information Centre for health and social care:
 Maximise the value of data collected
 Encourage innovation in information & analysis markets
 Source of data for DH, CQC and other official statistics.
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”
Your questions?