the health informatics review - from words to deeds the northern, yorkshire and humberside directors...
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The Health Informatics Review - from words to deeds
The Northern, Yorkshire and Humberside Directors of Informatics Forum
14 November 2008
Brian Derry
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
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• 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”
