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NHS journey With IT

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arafat arafat

on 1 August 2017

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Transcript of NHS journey With IT

NHS was created in July 1946 by national health service act 1946 to control health service in UK but each country has its own NHS Scotland , north Ireland except England and Wales "stayed together this service is free of charge in 1969 Wales has its own NHS as it leaves secretary of state for social services
NHS Birth
NHS was created in July 1946 by national health service act 1946 to control health service in UK but each country has its own NHS Scotland , north Ireland except England and Wales "stayed together this service is free of charge in 1969 Wales has its own NHS as it leaves secretary of state for social services
starting infrastructure
NHS starts with structure called tripartite system:
* Hospital service: 14 regional hospital controls other 400 hospitals .
* Primary care: especially GPs / dentists /others.
* Community Services: clinics provide different health services for community.

Now NHS employs 1.7m people (1.35m in England):
* 39,780 general practitioners (GPs)
* 370,327 nurses
* 18,687 ambulance staff
* 105,711 hospital and community health service

Starts in 1948 under white paper by the budget of £437 million (roughly £9 billion at today’s value) now in 2013 it is around £108.9 billion.

still free service though attempts to privatizes it through "internal market" by former Prime Minister, Margaret Thatcher in time of Blair Government it encourages outsourcing of medical services and support to the private sector but still free

in 1 April 2013 big changes occurs : still free services

* abolition of primary care trust (PCTs)

* strategic health authorities (SHAs)

* introduction of clinical commissioning groups (CCGs)

* increase life expectance decrease mortality of infants with high patient satisfaction

Commonwealth Fund comparison (Australia, Canada, Germany, Netherlands, UK ,New Zealand and USA) put UK 2nd

best system in efficiency, effective care and cost-related problems second in equality and safety
Common law duty of confidence:
confidential patient information disclosed only by :

-patient's consent
-required or permitted by law
- public good
Healthcare Commission, the Audit Commission and Primary Care Trusts have legal authority to disclosed patient information

Computer Misuse Act 1990 :
identify all wide threats to medical record and important when systems and record being used by unauthorized party.

3-Access to Health Records Act 1990 applies to records created after 1st November 1991, determined who has right to access to medical record.
11-The Data Protection Act 1998: 8 principles define processing conditions like recording, storage, manipulation and transmission of legal personal data

health information (sensitive part)[ patients' rights to access to their medical records and applies to electronic and paper-based record systems
aware about who will access to their personnel information (fairly and lawfully processed /processed for limited purposes /adequate, relevant and not excessive /accurate /not kept for longer than is necessary /processed in line with subjects' rights /secure/not transferred to countries without adequate protection )

4-Freedom of Information Act 2000: general right of public access to all types of recorded information held by public authorities. Time to response to a request for information within 20 working day.
for GP's this law apply for general information not for personal health information.
5-The Health and Social Care Act 2001( with amendments in 2006 and 2008) make regulations to enable, or require the release of, patient information where disclosures would otherwise be restricted by the common law

Electronic Communications Act 2000: allows creation and transmission of prescriptions electronically under certain conditions.

The General Medical Services (GMS), Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS) Regulations and Directions 2004 :only under Code of Practice(GMS) can override common law of confidentiality allow Primary Care Organizations (PCOs) to have all information from health practice with no responsibility on it but when strictly necessary and that anonymised
10-Mental Capacity Act 2005 patient lacks mental health capacity senior health professional can act in the patient's best interests.
The Terrorism Act 2000:

Section 19

obligate information disclosure of information if act offence committed

Section 34 obligate information disclosure of information if related to Serious Organised Crime Agency

The Access to Medical Reports Act 1988: allow patient to see their own medical report before or after (till 6 months) unless

*information will cause harm to patient [mental / physical]

*information of third party with no discloser .

1- Getting Better With Information In 1992:
* White Paper The Health Of Nation
* Information person based / from operational system / secure and confidential / share across NHS
2-Implementing The Infrastructure For IM&T in The NHS
* Develop IM&T infrastructure across NHS

Information For Health a patient record for every one in UK from cradle to grave 24h/365day access to patient record / information available Ability to share information across NHS
Delivery 21st Century It Support For The NHS Service is patient centered Effective / fast to find key information Good quality – better management & delivery of service – support information management

1- The introduction of national standards and accountability
• National Service Frameworks (NSFs) responsible for standard for national care and set models of how to deliver this care for patient eg: mental health (September 1999)/ Diabetes NSF Standards(December 2001)
The National Institute for Clinical Excellence (NICE); authoritative guidance on which evidence-based guidelines treatments work best for patients also what scientific development accepted for patient care and its implementation also enhance innovation across NHS and health stockholders

• the Commission for Health Audit and Improvement (CHAI) aiming to improve healthcare quality provided by NHS, demolish all variation in healthcare service provided by NHS by monitor evaluate compliance of NHS with former 2 organizations

National Patient Safety Agency (NPSA)
i: created to co-ordinate healthcare effort , learn from NHS adverse incidents also insure reporting of it in its first place this done by enable all healthcare providers to report errors without fear.
2- The introduction of national standards and accountability
according to "Shifting the Balance of Power" document
local NHS accountability organization have power on decision-making and investment creating two organizations:

a) Primary Care Trusts (PCTs) responsible for

*develop local health plans and strengthen health function
*ensure delivering of all health care services for population
* take place of NHS in partnership with authorities
* control develop and integrate all family health services

b) Strategic Health Authorities (SHAs)
* create framework to develop organization
* manage all system performance
* develop clinical network and strategies all over NHS

3- An increase in the flexibility of services:
"Keeping the NHS Local" has three core principles:
* change with people through patient experience, improve choice and develop new ways to deliver services
* redesign not relocation of service to meet needs and expectations
* take all different NHS system component s view for more integration and service planning
provide new solutions strategies & models will lead to increase quality , care and support work safely without increase workload

4- Greater choice for the users of services:
to enable patient to choose whenever , wherever ability to manage all their treatment variable " time , date , location , nature , etc. …." (3)

1-Hospital Information Support Systems (HISS)

Pilot projects start with initiative of £56 million

* 3 main pilot projects, at Nottingham, Darlington and Greenwich (£32 million ) Hospital administration

* 16 projects at 25 hospitals with financial support of £48 million

* Pilot projects Strategy focus Infra-structure (data model) Lead organization Information Management Group

* National Audit Office inquiry Significant delays in implementing key systems.

2-EPR programme

* attempt to achieve NHS strategy “Getting Better with Information” in 1992

* Developing an IM&T infrastructure

*scope of project include whole Hospital

* it had a Decentralized approach focuses in both Clinical & Developing working record

* Strong management ( both Management/clinician partnership ) it lead by Information Policy Unit

* Queen’s Hospital, Burton and Wirral Hospital achieved successful hospital-wide implementation of EPR

to achieve NHS strategy “Information for Health”
* “Lifelong electronic health records for every person
in the country”
* pilot project with Scope get more wider to include Primary / Secondary /Community health care institution
* information authority aiming to Developing working record
Electronic Record Development and Implementation Programme (ERDIP)
*initiated to achieve NHS strategy
“Information for Health” :
* EHR for every person which can be accessed any time anywhere providing seamless care through every part of NHS direct booking, referrals, discharge, pathology messages

Responsible organizations
1-NHS Connecting for Health (NHS CFH)

Part of the Department of Health Informatics Directorate created by department of health to deliver NPFIT & other IT related projects
Its role is to maintain and develop the NHS national IT infrastructure. This infrastructure includes a number of national services and a range of national applications.Started in 2004 and terminated in 13 march 2013

Replaced by Health and Social Care Information Centre

2-The Health and Social Care Information Centre

created according to Health and Social Care Act 2012

is a trusted resource of authoritative data, information and technology resource for all patient caring centers across NHS . It supports the delivery of IT infrastructure, information systems and standards to ensure information flows efficiently and securely across the health and social care system to improve patient outcomes.

1- previous projects developed by local trust with limited data interaction and rejection of external projects (2)

2- vision of
modernize medicine
NHS .(2)

3- To insure patient data exchange, standardize NHS with same standers . (2)

4- Changing demographics (4)

5- Obligatory search for cost containment (4)

3-Goal :
Since NPFIT established in October 2002 it aim to provide an electronic NHS Care Record for every patient at the national level by 2010 most ambitious

implement an integrated IT infrastructure for all NHS organizations

will connect over 100,000 doctors, 380,000 nurses and 50,000 other health professionals

create an electronic record for 50 million patients

4-Main Components & progress :

A) Choose and Book

is The electronic booking service ease booking of hospital or clinic appointments to 1ry care health care personnel for patient (5) achieve 95% of GP clinics in March 2008 low in adoption as achieve only 31% in March 2008 while it should as planed achieve 90% by March 2007 Consortium Leader Atos Origin Main Supplier Cerner with Value £ 645,000,000

B) The NHS Care Records Service (NHS CRS) :

2002 Integrated Care Record System changes under name of NHS Care Records Service (NHS CRS)

leaded by National Programme for IT focused on Infra-structure (Emphasis on infrastructure and “ruthless” standardization) Centralized with wide scope include NHS (+ social care) to improve these record across NHS facilities .(5)

B) The NHS Care Records Service (NHS CRS) :
* to apply NHS strategy “Delivering 21st Century IT support for the NHS”
* include:
a) demographic data ( age / NHS number / address / gender / etc.)
b) clinical data ( allergy , side effects , chronic conditions , cases summery , medical history)
c) approval or disapproval to view NHS care record
B) The NHS Care Records Service (NHS CRS) :

In the place of the adoption of the original standard record systems there has been patchy adoption of:

* "Interim solutions" -products that better fit local conditions

*"PAS solutions" training programs with no clinical information


To deliver common and full electronic care records to all London NHS Trusts program proved impracticable and failed

For London: (IDX)

Revised plan from 2007

For Southern: (IDX)

Main contractor (Fujitsu) left the programme in June 2008

For North, Midlands and East: (iSoft)

Originally three separate clusters, all three were merged. . Main contractor (Accenture) for two clusters withdrew in Sept 2006.

Main EHR suppliers:
1- Cerner
since 2004 Cerner Millennium in 16 trusts / 70 hospitals Choose and Book appointment scheduling system(processed more than 15m patient bookings ) London and the north, Midlands and east regions
2- Isoft
second major firm offering EHR systems ( iSoft's Lorenzo suite) London and the north, Midlands and east regions
3- Emis
Emis - Egton Medical Information Systems claim to have half of GP practices / 35m patient records. In September 2010, Emis Web used by more than 1,000 early adopters across the UK
4- Alert Life Sciences Computing
Alert's touch-screen system more than 70 staff working in the UK Blackpool-based village

5- Orion Health
originally piloted at Northern Ireland's health and social care trusts in 2009-10 provide (web-based Concerto)
6- CSE Healthcare Systems
CSE's RiO care records platform used by 40,000 clinical staff across London and the south,
7- InterSystems
InterSystems Ensemble® started by Royal Marsden Hospital back in 2007 expanded through Barts and the London trust.
Scotland : TrakCare as national patient management system
8- TPP
Leeds-based TPP's SystmOne supports a centrally hosted GP(1,600), community / child health record.
Five of the nine GP surgeries in Richmondshire planning to use it

Choose HL7 Version 3 NHS Connecting for Health make all message specifications, including business requirements documents available to HL7 UK Members in the document repository.( http://www.hl7.org.uk/repository/mim.asp)

why ????

* facilitate information exchange between multi supplier system

* great support

* international stander (developed with UK association & economic benefits )

* Robust approach to development

* saving time

Messaging System
The national, central database (Spine)
stores the summary of NHS CRS with location of original one ensure important clinical information accessible and accessed through summery record Technical delivery in releases from May 2006.
Consortium Leader British Telecom, Main Supplier CSW with Value £ 620,000,000
The summary care record (SCR) delayed by 2 years for technical reasons / consultations on patient confidentiality adopted since March 2007

Decision support systems
the electronic prescribing program: send prescriptions electronically to pharmacy for efficient and convenient prescribing/dispensing for patients and staff. online knowledge and library systems: integrated care pathways; e-referral support; support for ordering clinical investigations ; etc.

IT supporting primary care
Quality Management and Analysis System (QMAS - collects national achievement data, responsible for payment value earned by GP practices now it replaced by Calculating Quality Reporting Service (CQRS) which will calculate payments starting from 2013/2014

GP2GP (enables the transfer of electronic health records among GP practices)

Picture Archiving and Communications Systems (PACS)
digital medical images brought in 2004 100% deployed December 2007 before scheduled by 3 months with rapid uptake (case studies)now evry trust is going for their own local contract after leaving NPFIT contract .

as 30 June 2013 in the North West, West Midlands and the South / 31 July 2015 in London / 30 June 2014 in the North East, East of England and East Midlands (with an option to extend for a further 24 months

NHS mail/NHS mail 2
a NHS secure, resilient ( two centers so easy recovery ) 24x7x365 service , central e-mail (available anywhere) safe enough to send patient data by email uses Microsoft Exchange 2007 and of course free charge services ( sms ,etc. ) delivered on time in Oct 2004 with problems in adoption as only 43% in May 2008 using it

The National Network (N3)
IT infrastructure and broadband connectivity for the NHS delivered in January 2007 two months before schedule Consortium Leader British Telecom with Value £ 530,000,000

The Health Space web service
allows patients to access their NHS care records service was not popular so closed on 14th December 2012
Electronic Transmission of Prescriptions (ETP)
between General Practitioners (GPs), pharmacies and the Prescription Pricing Authority (PPA) it infrastructure for NHS

Start from 2002/2004
in 2002

NHS/CFH launch NPFIT where NHS Trusts where consultation and also end users were also consultation

in 2003

NHS/CFH define ( application , start bidding, announce winners ) service providers ( create consortia , submit bids )

in 2004

NHS/CFH detailed negotiation of contracts service providers (Negotiations , Implement Choose and Book) NHS Trusts Pilot Implementations of standard applications end users were General support for the concept of electronic records

progress in product and evaluation

Fate of programme
NPfIT Dismantled: UK Government Announces End of its £12.7 Billion National Electronic Health Record Program

Program world biggest program coasts £12.7 billion has been dismantled but some elements still active like letting local NHS have choice for EHR for best choice of money also NHS refuse to cancel £4 billion contact with CSC and BT main supplier.

real coast of program never been determined as some coast absorbed due to supplier didn't deliver and never billed out


Six reasons why the NHS National
Programme for IT failed
NPFIT was "Top-down" projects so have high chance to fail than if it was "bottom-up" projects as it was done at political reasons this cause failure of program as this should come from specialist and whom know and work inside the system.


poor strategy and business planning

from the start it was obvious that there was no understanding of drivers and value of project . even inside NPFIT outcome of the project wasn't clear also major concerns of doctors and GPs, about the accessibility and utility of the planned system (good consultation)

3.More haste, less speed

Insufficient planning and haste towards Contract awarding without clarifying project scope (what project is about, deliverables implementation,)

4.Poor contracting process

"take-it-or-leave-it" basis with no negotiations / very aggressive contract terms with legal reminds so they inhibit possibility for long-term smooth relationship with contractors also harsh strategies and there no balance between risks of program and rewards of it
5.Multi sourcing
Many providers for different service provided by npfit with no harmony between each other obligate to work together and fail due to lack of co-operation


Tendency to abort the project either early ( without take rightful measures like evaluation of project in every step and compliance with original goals ) or late ( delaying in taking right step in right time )

What after NPFIT
Paperless at 2018
Strategy was reformed to be paperless at 2018
new standard been announced in NHS UK 11/7/2013
These standards about electronic record developed by
both Royal College of Physicians (RCP)/Health and Social Care Information Centre (HSCIC)
approved by Academy of Medical Royal Colleges standard support
* Access to updated information fast/secure
* Fast access – relevant information – improve quality decision
* Measure system quality through quality of information
*Better clinical outcome – NHS provide better service
This is the new aim
Child Protection – Information Sharing project (CP-IS)
will improve the way that health and social care services work together across England to protect vulnerable children
national electronic referral service which gives patients a choice of place, date and time for their first outpatient appointment in a hospital or clinic.

NHS Choose and Book
Clinical Audit Platform
will provide a single standard technical platform for all of the clinical audits. This will be easily accessible by all NHS staff providing data.

Personal Demographics Service
national authoritative source of patient demographics data for the whole of the NHS.

Clinical Safety
promote and help embed clinically safer working practice methods and patient safety solutions, enabled by IT, applied consistently across the NHS.

Clinical Record Standards
provide a consistent way of collecting information for the NHS that is
assured by professional bodies
and patient representatives
Estates and facilities management information system :
collects data on: Surplus Land, Emergency Preparedness, Fire Incidents, Non-Medical Equipment Defects and Failure Incident Reports, Hospital Estates and Facilities Statistics, Degree Days and Patient Environment Assessment Team (PEAT).

Electronic Prescription Service (EPS)
enables prescribers - such as GPs and practice nurses - to send prescriptions electronically to a dispenser (such as a pharmacy) of the patient's choice. This makes the prescribing and dispensing process more efficient and convenient for patients and staff.
enables patients' electronic health records to be transferred directly and securely between GP practices. It improves patient care as GPs will usually have full and detailed medical records available to them for a new patient's first consultation
GP Systems of Choice
scheme through which the NHS will fund the provision of GP clinical IT systems

Hospital Estates and Facilities Statistics :
online system contains annual data from the Estates Return Information Collection (ERIC) from 1999/2000 onwards. It has a wide variety of information on estates and facilities
Public Health Services Network : provides fast, broadband networking services to the NHS, offering reliability and value for money.
Indicator Portal
brings a range of health indicators together in one place. Providing quick and easy access to hundreds of indicators, it's a valuable information resource for all health and social care professionals, not just information specialists.
Indicators for Quality Improvement
Developed in partnership with clinicians, you can use the Indicators for Quality improvement for benchmarking and improving local services. You can download data and view detailed metadata for over 200 indicators.
Informatics Capability Development (ICD)
Offering support materials, guidance and toolkits to help individuals and organizations in the NHS, DH and other healthcare-related organizations to develop their informatics capability in a changing environment.

Information Standards :
Information Standards delivery provides products and services to assist the collection, management and sharing of health and social care information to support patient care.

The Mental Health Minimum Data Set
contains record-level data about NHS services delivered to over a million people with severe and enduring mental health problems each year between 2003 and 2011. This website accompanies the Mental Health Bulletin publication and provides trust-level breakdowns for the national statistics presented in the Bulletin. These are shown as graphics with year on year comparisons.

Information Governance (IG)
ensures necessary safeguards for, and appropriate use of, patient and personal information. Key areas are information policy for health and social care, IG standards for systems and development of guidance for NHS and partner organizations.
National Adult Social Care Intelligence Service
is a single national resource of social care information . The website has a collection of data, tools and resources designed to meet the needs of service planners, managers, researchers and policy makers and others.
Major stakeholders of any system should participate in taking decisions and their opinion about new project should be counted also for project to succeed it must start from bottom up model to decrease any possibility of failing
Before buying any system first you must determine your scope , requirement , outcome and have good consultation with your stockholders
In contracting evaluation must be done carefully terms should be under rightful and fair negotiations with two side contracts for long term contracts
For multi sourcing collaborations between different vendors working together is a must to avoid any delay , failure for projects
Project leaders should have clear vision , firm hand and in same time evaluate project advancing and compliance with original plan

1- Ken Eason, Emeritus Professor - Dept of Human Sciences, Loughborough University Senior Consultant, The Bayswater Institute , NPfIT: The NHS National Programme for Information Technology A Sociotechnical Systems (2008 ) Perspectivehttps://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&ved=0CC8QFjAA&url=http%3A%2F%2Fwww.bcs.org%2Fcontent%2FconMediaFile%2F9815&ei=r6LfUay6GcnlPOaEgYgN&usg=AFQjCNHNlRW0RfR5YQ_VRiCXbESP8ktvSg&sig2=5IMsB7Un_lieK8fnLWpHsA&bvm=bv.48705608,d.ZWU(accessed 1 july 2013).

2- Committee of Public Accounts , The National Programme for IT in the NHS: an update on the delivery of detailed care records systems Report number: 45 Published on 3 August 2011 (accessed 1 july 2013).

3- Integrated Care Records Service INTRODUCTION to the Output Based Specification, NHS national programme for information technology ,

4- Adam Hanina , Visiting Fellow of Imperial College Executive Director of The European eHealth Forum NPfIT, Context and Implications 2005 https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&ved=0CDQQFjAA&url=http%3A%2F%2Fwww.medetel.eu%2Fdownload%2F2005%2Fparallel_sessions%2Fpresentation%2F0407%2FNPfIT.pdf&ei=aw_gUYK4F4LXPeD8gaAC&usg=AFQjCNEIvXbQfvLjIFaqQ3LOb9RIzz9og&sig2=RCM5h6x5r2UBZNPqLgtZCg&bvm=bv.48705608,d.bGE (accessed 1 july 2013).

5- Laura Sato , NHS Connecting for Health Delivering the National Programme for IT HL7 Netherlands / NICTIZ Meeting, May 2005,(accessed 1 july 2013).


Does it affect physician style
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