The Health Informatics Review

NHS IC Supplier Forum23 September 2008

Brian Derry

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 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, on 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 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

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

Information available at the point of care

Health record securely accessible to clinicians

and patients

Personalised wellness support

for patients & public

Public access to service information

Improving clinical quality and safety

Improving performance management

Improving information for staff

Share informationsecurely with partners

Public access to health information

Information to support high quality care

HIR 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 used many times, only creating new data when absolutely

necessary; with an integrated programme to improve data quality

Responding to clinical priorities

Achieving the strategic vision:• Investigate interim solutions, including widening choice of LSP solutions• Trusts’ roadmaps by April 2009 describing how strategic vision will be

achieved• Local solutions subject to convergence with LSP & national strategic

direction, & to local funding & business cases

Early delivery of priority secondary care products (“clinical five”):• Patient Administration System (PAS) integrated with other systems & with

sophisticated reporting• Order Communications and Diagnostics Reporting - all pathology & radiology

tests and 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. People and Skills

4. Processes and Structures

Strand 1:Information & Standards

Information actions

• Filling gaps, e.g clinical metrics, community, mental health, social care

• Data quality• Syndication• Signposting• Streamlining data collections

Standards aims

• Fundamental review of the (1970s) NHS data model to create a new model suitable for a 21st century NHS

• Short- term improvements to 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 exchange of patient information with 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 the widespread adoption of existing standards (e.g. NHS number, SNOMED)

Information 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, child & 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

Strand 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 to support 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

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

Strand 3:People & Skills

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 has formal responsibility for providing 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” h

• National informatics leadership to: develop the profession co-ordinate the existing expertise build the informatics capability of the general and management workforce

Skilled staff

• Creation of a health informatics career framework, mapping to the wider NHS career framework, to guide the development of staff who wish to progress

• Health Service leadership to address the skills needed in the NHS needed to deliver large scale IT-enabled change and to develop the Informatics Profession.

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

• SHAs and NHS CFH to work with suppliers on supplier capability to help ensure that planned milestones are met & products are fit for purpose.

Strand 4Processes and Structures

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

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 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

• NHS Connecting for Health: Centre of IT expertise for NHS, not just implementers of NPfIT Embrace private & voluntary healthcare providers, & Social Care

• Information Centre for health and social care: Maximise the value of data collected

Improve data qualityEncourage data re-use through a ‘syndication service’,Promote access through information signposting service

Encourage innovation in the information and data analysis markets Be the 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”

Questions?

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 currently have to access many different internal information & IT systems to do their jobs

• Staff Gateway to provide: ‘one-stop-shop’ for the key information sourcesProfessional 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

• Further developments of NHS Choices: much more information, not just about hospital care but also

about 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