the health informatics review - from words to deeds the northern, yorkshire and humberside directors...

The Health Informatics Review - from words to deeds

The Northern, Yorkshire and Humberside Directors of Informatics Forum

14 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:

StrategyCommitments

• 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 staffpublic opinion researched, through a deliberative event,

online questionnaire and surveyvoluntary organisations and professional bodiesSHA & NHS Chief Executive Officers and Chief

Information Officers

• Findings published as part of NHS Next Stage Review, 10 July 2008

HIR scope

To outline an information and IT architecture capable of supporting the world-class NHS envisaged in the NHS Next Stage Review

Health Informatics Review Programme

Project 3

Creating aninformation system and management

structure

Project 1

Meeting the information needs of theDH and NHS

“Information” “NHS CRS and SUS”

“Governance”

Project 2

Maximising the benefits from NHS CRS & SUS

NHS Next Stage Review

High quality care for all: NHS Next Stage Review

Quality at the heart of the

NHS

High quality care for patients and the public

Freedom to focus on quality

High quality care for all

Raising standards

Stronger involvement of clinicians in decision making at every level of the NHS

Fostering a pioneering NHS

Empowering frontline staff to lead change that improves quality for patients

Valuing the work of NHS staff

Help to stay healthy

Empowering patients

Most effective treatments for all

Keeping patients as safe as possible

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 prioritiesAchieving 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 metricsCommunityMental healthSocial care

• Streamlining data collections• Data quality• Access and use:

Syndication & SignpostingStrategic reporting solution

Data Quality Programme

DQ LexiconSignposts to

existing tools and good practice. Special

interest groups andforums.

DQ AccreditationOrganisational DQ

Standard framework.Self assessment tools.

Formal audit. DQ monitoring.

DQ TouchstoneComparator

Quality IndicatorsAcross datasets and collections. Linked to

data catalogue.

DQ GuildStakeholders

Organisation repsInformatics professionals

Frontline DQAwareness and

education. Impact ofdata quality on patients,organisations and staff.

Basic DQ guidance

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

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

GP Extraction Service (GPES)

• Extraction of GP data on a national basis for: improved disease surveillance clinical audit commissioning patient services improvements in managing public health allocation of NHS resources

•GPES will: co-ordinate approved extractions provide high quality analyses protect patient interests - data only used for purpose for

which approved•GPs may opt out of individual extracts

•Openness, transparency and engagement with stakeholders

GPES components

GPES scope

Extraction Query

Custom

ers

All G

P P

ractice systems

Data management

Analysis

Contractor / supplier

responsibility

ICGP Extraction Tool (GPET)

IC data handling and analysis

tools & technologies

Honest Broker

CfH

In

fras

tru

ctu

re m

ade

ava

ilab

le e

g R

BA

C,

N3,

PD

S,

Pse

ud

on

ymis

atio

n e

tc

• Part of the current SUS programme

• Comparative analysis of service quality, efficiency and effectiveness

• Replace Hospital Episodes Statistics Service when current contract ends

• Supports NSR goal: Empowering frontline staff to lead change that improves quality for patients.

Strategic Reporting – NHS Analysis and Reporting Service (NARS)

Information reporting programmes

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

Delivering better, safer

careQuality at the heart of the

NHS

Empowering staff to

improve NHS performance Freedom to

focus on quality

Empowering patients and

the publicHigh quality

care for patients and

the public

Systems supporting high quality care

NHS Care Records Service – Summary & detailed recordsChoose and BookPACSElectronic Prescription Service

Secondary Uses ServiceClinical DashboardsNHS ComparatorsStaff GatewayResearch Capability ProgrammeGP Extraction Service

NHS ChoicesHealthSpace

N3Spine

NHSMail

Clinical dashboards

Clinical team, ‘day-to-day efficiency’ dashboard

Clinical team, ‘day-to-day efficiency’ dashboard

Monthly ‘quality of care benchmarking’

dashboard

Monthly ‘quality of care benchmarking’

dashboard

Individual, ‘comparative

clinician’ dashboard

Individual, ‘comparative

clinician’ dashboard

Locally defined dashboards: improve patient

flow & treatment patterns; multi-disciplinary.

Rapid updates (up to every 15 mins)

Locally defined dashboards: improve patient

flow & treatment patterns; multi-disciplinary.

Rapid updates (up to every 15 mins)

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.

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.

Allows clinicians to monitor individual

metrics, compared with peers. ’Portfolio’

contributes to continued accreditation with

professional bodies.Weekly/monthly

updates.

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 preferencesrecord self-administered drugs & health

monitoringlet 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

Within DH & NHS

Outside DH &

NHS

Investment

assessment

Standards governance

Policy integratio

n

Informatics staff

Other staff

Sound leadersh

ip

Good processe

s

Skilled 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 & to develop the Informatics Profession

• Informatics content - to agreed national standards - in core training & professional development for NHS clinicians and managers

• Local leadership, prioritisation & delivery, with central support & resources

• Informatics career pathways• Apprenticeship, graduate training & talent

management schemes.

Priorities

• Visible professional leadership, centrally and by SHA CIOs• Promoting the role of CIOs on NHS Boards, following the model of

CIO for Health• Accreditation of informatics services, including processes & people• Initial focus on IT, information management and Programme and

Project Management (PPM) specialists• Encourage registration with the United Kingdom Council of Health

Informatics Professions (UKCHIP)• Subsidiarity for professional development - stronger local focus for

governance, prioritisation and delivery, supported by nationally• Access to additional skilled resources to support local

implementations, e.g. central support teams, national call-off 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 servicesempowering 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 CEOon 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 NPfITEmbrace private & voluntary healthcare providers, & Social

Care

• Information Centre for health and social care:Maximise the value of data collected Encourage innovation in information & analysis marketsSource 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?