Setting Standards for EDM and Delivering a Paperless NHS

Setting Standards for EDM & delivering a paperless NHS

EDM Conference 1st October 2014

Martin Severs, Clinical Professional Lead and Caldicott Guardian

Presentation

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• HSCIC?

• Standardisation Committee for Care

Information [SCCI]

• Electronic Documents some observations

HSCIC:

Who are they?

Are they part of the NHS?

3

August 2014: Work by MORI on behalf of NHS England

What we do

We set standards that protect

patient’s confidential information, reduce

bureaucracy and improve data quality

We operate essential technology services

that support the health and care system

We collect, analyse and publish

national data and statistical information

that helps inform decision making

We develop the next generation of

national data and information systems

Who we are

What we do

NHS Mail

600,000 registered

users

GP2GP

89% of clinicians

agree it improves

patient experience

The Spine

Contains 80

million records

NHS Choices

Handles 29 million

enquiries a month

Electronic

Prescription

Service

Potential to save the

NHS £179M a year

Informing public

discussion

3,000 news stories

used our statistics

What we do

GP Payments

Service

Calculates and pays

over £7.2 billion

annually

Choose and Book

50 million patients

referrals reached

Statistical

reports

220 statistical

reports published

Screening

Helps to detect over

13,500 invasive

cancers

National Back

Office

Manages accuracy

of 6.3 million

transactions

SCCI


• Why do you need it? – Each major organisation in the health and social care

system has its own primary legislation

– This legislation often gives specific powers with regard to data

– Health and Social Care Act 2012 gives new powers and duties in the data and information standards arena

Directions; Information standards approval, collections

– Within the ‘combined sovereignty’ structure called the National Information Board all the major organisations within the health and social care system have agreed to work to the common good

One strategy with shared actions; less duplication and overlap; efficient use of resources; less bureaucracy and burden; maximum data asset utilisation;

SCCI


• Idea to Need stage

– Anyone can have an idea and bring it to the

service

– If it is for data; do we have any of it?

– If it is for a new standard is there already one?

– If it is completely new who is backing it and who

is going to pay for it? [Sponsor, SRO, developer]

– Is it worth considering in the business plan of one

or more H&SCS organisations

SCCI: Idea to Need


idea

Supported Statement

of Need

SCCI: Requirement stage


• Requirements submission consists of three documents:

– The Requirements Specification IEEE 830 – 1998 specification is recommended for

consideration.

– The specific health and social care system [H&SC system] requirements Patient safety, implementation, test etc

considerations

– The Outline Business Case

SCCI


idea

Supported Statement

of Need

Requirement

Business

Plan Business

Case

Process

Outline

Business Case

SCCI: Draft Technical Regulation [DTR]


• DTR is defined by EC Technical Standards and Regulations Directive 98/34

• There should be up to 17 documented attributes of a Draft Technical Regulation

• Particular points to highlight: – Lawful processing requirements

– Safety case and clinical authority to release

– Implementation plan

– Proposed information standards notice

– Tolerance

– Burden

– Full Business Case

SCCI


idea

Supported Statement

of Need

Requirement

Business

Plan Business

Case

Process

Outline

Business Case

Draft Technical

Regulation

Full Business Case

SCCI: Technical Regulations


• Key point of a (full) Technical Regulation is ‘the observance of which is compulsory’

• Technical Regulations come within the scope of the EC Directive 98/34 so the most crucial step is to assess whether a particular instance needs to be notified to the EU. If ‘yes’ then there is consultation and the specification must be capable of modification on the basis of feedback

• Completion of guidance produced by BIS

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/292896/bis-13-1205-technical-standards-directive-98-34-ec-procedure-guidance-for-officials.pdf

Public consultation MUST take place either at DTR or TR stage [s258 H&SCA

2012]



























SCCI


idea

Supported Statement

of Need

Requirement

Business

Plan Business

Case

Process

Outline

Business Case

Draft Technical

Regulation

Full Business Case

Full Technical

Regulation

Full Business Case

SCCI


• Information Standards – The publication of the Approval Letter by SoS and NHS

England on their web sites AND

– The distribution of that letter by a HSCIC managed notification service AND

– The publication of the Approved Information Standard and its associated implementation guidance and support materials via the HSCIC

• Collections – The publication of the Approval Letter by HSCIC on their

web site AND

– The distribution of that letter by a HSCIC managed notification service AND

– The publication of the Approved Collection and its associated implementation guidance and support materials via the HSCIC

SCCI


idea

Supported Statement

of Need

Requirement

Business

Plan Business

Case

Process

Strategic Case

Draft Technical

Regulation

Outline Business Case

Full Technical

Regulation

Full Business Case

Approved

Information

Standard Small

change

Large change HSCIC

required

collection


• Electronic Document Management

Systems:

Some perspectives

Electronic Document Management [EDM]


• EDM versus Electronic Record Management Systems

• ISO 15489 (paragraph 7.2) gives the general characteristics of a record as: – ‘ a record should correctly reflect what was communicated

or decided or what action was taken. It should be able to support the needs of the business to which it relates and be used for accountability purposes’.

• One of the principal properties of an electronic document (as opposed to an electronic record) is that it can readily be edited. Preventing this from happening to records where it should not and auditing where it has apparently happened are vital issues.

• My focus is on ERMS as opposed to EDMS

ERMS: Core requirements1


• Build and maintain a classification scheme, against which folders are classified

• Manage folders, parts and records, and their metadata

• Declare an electronic document as a corporate record, and to maintain its integrity as an authentic representation of a business action or decision

• Search for and retrieve records

• Consistently manage the retention and disposition of whole folders and records,

ERMS: Core requirements1


• Retaining what should be kept and disposing

of what should not, whether by

• Transfer to another organisation or

destruction

• Control access to folders and records, and to

maintain an auditable track of actions taken

on them

• Provide manageable, usable and robust

mechanisms to carry out core functions.

ERMS: additional health & care requirements


• Authentication and encryption – facilities enable integration with standard digital signature and certification

technologies, particularly where this is related to transactional records received in this way.

• Document management – facilities enable an integrated document and records management system to be

offered, so that the whole document and record lifecycle can be managed, from the creation, drafting and formalisation of documents to the declaration, management and disposal of records.

• Hybrid and Physical folder management – enables legacy paper records to be managed alongside electronic records; and

for an integrated approach to continuing paper records in the form of hybrid folders.

• Content management – Professional records structure

• Casework and workflow

• Image management and document scanning

• Preparing records for transfer – Transition communications handover, discharge, referral etc

ERMS Metadata


• supporting record retrieval;

• supporting the wide range of records management processes in the Functional

• requirements;

• establishing the provenance of the record – (ISO 15489 describes this as ‘the context in which the record was created,

received and used should be apparent in the record, including the business process of which the transaction is part, the date and time of the transaction and the participants in the transaction)’;

• showing whether the record’s integrity is intact (e.g. it has not been subject to changes after being fixed as [or ‘declared’] a final record);

• ‘demonstrating that the links between documents, held separately but combining to make up a record, are present’;

• demonstrating that the relationships between separate records are present;

• providing essential information to support interoperability / sustainability of the record between platforms and across time and technological platforms5.

Definition of metadata given in ISO 15489 runs: ‘data describing

context, content and structure of records and their management through time’.

History: Have we moved?


The Tunbridge Report

1965

• Standardised records

• Primary & secondary

• Standardisation of

documents

• Recommended the NHS

number

• Recommended “data

processing and the use of

electronic forms of

mechanisation”

• Recommended standard

discharge summaries and

education for doctors!

Academy of Medical Royal Colleges &HSCIC


• Standards for the clinical structure and

content of patient records

• 2013

Good information is an important part of making sure people stay healthy and get the best care

The Power of Information, Department of Health

Healthcare

Setting Standards for EDM and Delivering a Paperless NHS