BCSASSIST Submission to the Conservative Party Independent Review of NHS IT

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A game of two halves and two personalities

• BCS-ASSIST Submission to the Conservative Party
  Independent Review of NHS IT
• Brian Derry, ASSIST Chair
• 2. What the NHS Information Centre can do for
  you
• Brian Derry, Director of Information Service, the
  NHS Information Centre for health and social care

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BCS-ASSIST Submission to The Conservative Party
Independent Review of NHS IT

• Brian Derry
• Chair of ASSIST National Council

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Background

• Independent Review Group, set up by the Tory
  Shadow Health Minister Stephen O'Brien MP
• Aim to inform the Conservative's policy for the
  use of IT in the NHS, health and social care in
  England
• BCS-ASSIST submitted its comments in September
  2008
• ASSIST, an association of 1,800 IT professionals
  in the NHS, has produced an excellent paper which
  summarises the best and worst in health service
  informatics. Tony Collins, Computer Weekly

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Remit of the Review

• Establish how clinical, public, and management
  needs can most effectively be met by information
  technology
• In the light of the developments and progress of
  the last few years, establish a vision for IT in
  the NHS, health and social care
• Set out a strategy for achieving that vision
  including a workforce strategy
• Advise on action for the current Government to
  take
• Advise on the policy options to be considered for
  implementation by an incoming Conservative
  Government

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The Review Group

• Dr Glyn M Hayes - GP, BCS UKCHIP
• Gail Beer - Independent Consultant
• Iain Carpenter, MD FRCP - Clinical Lead on Record
  Standards, Health Informatics Unit, Royal College
  of Physicians 
• Ian Shepherd, MRPharmS, FBCS, CITP  
• Professor John Williams, Director, Health
  Informatics Unit, Royal College of Physicians

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Set questions - 1

• Strategy
• What are the strategic objectives that can be
  supported through use of IT and information in
  health and social care?
• Capture and use of clinical data for individual
  patient management
• What are the advantages and disadvantages of
  using person-centred data captured in
  patient-focused records?
• How should patient and service user outcomes best
  be measured?
• What are the benefits and disbenefits of patient
  and service user recorded outcome measures?
• Who should perform the necessary data capture,
  how should it be done, and how can accuracy be
  ensured?
• What are the key issues with regard to data
  quality?
• How important will it be to introduce
  professionally-agreed clinical standards for the
  data captured in patient records?

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Set questions - 2

• Patients
• How are those who are disadvantaged, have a
  disability or are not computer literate affected
  by the increased use of IT in the delivery of
  health and social care?
• Management of the NHS, health and social care
• How can the delivery of health and social care be
  better supported by IT?
• How should data to support the management of
  health and social care be derived?
• How could IT support commissioning in health and
  social care?
• Health and Social Care
• How could information be beneficially shared
  between health and social care?
• Information Governance
• What are the relevant issues and tradeoffs with
  regard to security, confidentiality and data
  governance?Who should have primary
  responsibility for the content of a shared record?

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Set questions - 3

• The approach to system architecture
• What is right balance between centralised and
  decentralised systems?
• Should systems be designed and built to support
  specific diseases, interventions, professional
  disciplines or patients, regardless of their
  clinical problems?
• What future technical developments could affect
  the use of IT in health and social care?
• What role might other informatics models play
  (Google Health, MS Vault, open source etc)?
• What role, responsibilities and structure might a
  national centralised IT support body have?
• How can the system procurement process be
  optimised to maximise and sustain benefits?

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Set questions - 4

• Evaluation
• How should new and existing systems be
  evaluated?
• Leadership and Human Resources
• How can professional leadership be best developed
  and used to encourage the effective use of health
  and social care informatics and to support
  patient and service user care?
• How can staff commitment be maximised at the
  local level?
• How should the change process be managed?What
  education and training will health and social
  care staff need?
• How are the workforce in health and social care
  affected by the increased use of IT?

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ASSIST process

• Workshop, 24 September
• 30 senior informaticians NHS, CFH, IC, academia
• Facilitated by John Farenden, Tribal Consulting,
  under MOU with ASSIST
• Written contributions/comments
• Report submitted 30 September
• Publicity e Health Insider, Computer Weekly,
  Public Servant

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ASSIST themes -1

• Vision unchanged detailed, person-centric,
  securely accessible electronic records across
  health social care
• Pervasive IT public expectations
• NHS banking
• Building confidence public staff
• Media negativity
• NHS supercomputer
• Blaming schadenfreude

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ASSIST themes -2

• Unifying concept patient encounter
• Standards rather than standardisation
• Balancing local national
• One size does not fit all
• Responsibilities to wider community
• Building confidence
• Openness transparency
• Building on success learning from problems
• Encouraging SME suppliers

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ASSIST recommendations -1

• Get the basics resolved before trying the
  ambitious
• Do not lose or threaten the hard won successes
• Focus on (person-centred) standards
• Achieve a balance between technology, systems,
  people, process and culture
• Ensure much earlier and more integrated policy
  planning at both national and local levels

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ASSIST recommendations -2

• Invest in a systematic health informatics RD
  programme
• Avoid structural change
• Avoid stand-alone data demands
• Avoid insular systems development
• Invest in developing informatics skills,
  leadership and the profession

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Questions to you

• Was our broad analysis right?
• Were our recommendations right?
• What more can we all do to help advance the cause
  of informatics?

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The NHS Information Centre for health and social
care Business Plan 2009/10
Brian Derry, Director of Information
Services brian.derry_at_ic.nhs.uk
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The NHS Information Centre for health social
care
Vision To be the recognised source of relevant
health and social care informationMission To
drive the use of information to improve decision
making and deliver better care
The Information Centre has a primary aim to
become a key enabler of improved patient care
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Strategic Objectives
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In 2009-10 the NHS IC will focus on 14 programmes
which collectively will

• Deliver projects that help the NHS and Social
  Care frontline provide better care.
• Enable patients and the public to exercise
  choice.
• Strengthen the NHS ICs capacity and skills to
  deliver.
• Help build the capacity of frontline services to
  make best use of information.

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2009/10 NHSIC Programmes
Communications Programme
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Streamlining Data Collections
In 2007 the Department for Business, Enterprise
and Regulatory Reform set a cross-government
target to reduce the burden of data collection by
30 by 2010. The NHS IC will address this by

• Discontinuing/reducing a priority list of
  collections in order to meet the 30 target
  social care demands already cut by 28.
• Extending our regulation of information
  collections to include DH Arms Length Bodies and
  Strategic Health Authorities.
• Instituting a new impact assessment that more
  accurately estimates the end-to-end cost of
  information demands.

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NHS Information Reporting Service

• NIRS will improve information provision via
• Automatic collection of data from operational
  systems, particularly the NHS Care Record Service
  and primary care systems subsumes Secondary
  Uses Services
• Reporting and analysis services to support areas
  such as planning, management, research, audit and
  public health.
• Integrated framework of standards and IG

• Objectives
• Improve access to data to support the needs of
  the NHS and its stakeholders.
• Provide a range of tools and functionality to
  analyse, report and present data.
• Be the single, authoritative and comprehensive
  source of high quality data by
• Enabling linkage of data across care settings
• Ensuring consistent derivation of data items and
  indicators for analysis
• Improving the timeliness of data for analysis
  purposes
• Provide a secure environment maintaining patient
  confidentiality.

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NIRS logical model .the IM pathway
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Analysis Reporting Services within NIRS NARS

• Framework for the processing datasets for
  analysis and reporting
• Construction and presentation of indicators,
  across datasets, to NHS-wide standards
• Information presented via multiple channels
• Three phases
• National PbR Analysis Reporting
• HES Replacement NHS Comparators
• Future additions, e.g. Patient Reported Outcome
  Measures, other datasets etc

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NIRS NARS fit
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Secondary Uses Service part of NIRS

• Already implemented
• Data deletion services
• Data Quality reporting
• Reporting upgrades- Business Objects, Ardentia
• Systems enhancements RBAC, EDT, reference data
• Switch to CDSv6
• Still to come
• Choose and Book
• Mental Health MDS
• NSTS
• Pseudonymisation
• PDS
• 18 weeks RTT
• Release 5 due for release in April to support
  Payment by Results and Healthcare Resource Groups
  change

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Data Quality Programme
The NHS IC is initiating a wide-ranging Data
Quality programme to tackle the concerns
regarding the quality of health and social care
data, and its fitness for purpose.

• The programme will deliver
• A network of informatics representatives, who
  will help to shape and implement the programme.
• A portal providing access to best practice,
  quality processes, and quality comparators
  comparing data quality across organisations and
  data sets.
• Data Quality Accreditation Framework - which
  will provide organisations with a yardstick for
  data quality standards, processes, procedures and
  metrics.

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DQ Quotes

• Somebody, somewhere has already solved this
  problem if only we knew where to look
• We dont actually turn up every morning planning
  to create bad data
• Telling people off doesnt improve data quality
• Its no good just telling us we have 5 errors
  we need to know what the errors are so we can fix
  them
• People dont realise that bad data is bad for
  patient care, bad for income, and bad for
  reputation
• Most of the problems occur in gaps between
  systems, organisations, programmes, standards,
  responsibility.

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Data Quality Programme Products
DQ Guild Network of DQ champions and
practitioners
DQ Touchstone Comparator Quality Indicators
Frontline DQ Awareness and education.
SHA DQ indicator
DQ Hallmark Organisational DQ Standard
framework. Self assessment tools. DQ monitoring.
DQ Lexicon Signposts to tools and good
practice. Special interest groups
and forums.
www.ic.nhs.uk/dataqualityprogramme
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Informatics Data Standards Programme
The NHS IC is jointly leading with NHS CFH a
wide-ranging programme to update and improve
health and social care data standards, in
particular to focus on care quality using
patient-centred information.

• Logical Record Architecture (LRA) - what data
  should be shared across multiple applications,
  and how it will be managed, accessed and
  interpreted
• Datasets Futures develop new datasets to
  support commissioning and national policies
• End-to-end datasets process - to design a
  quicker, more integrated process for the
  development, testing and approval of new datasets
  standards
• Pathways Groups - evaluate the required standards
  from a pathways perspective
• Social Care - update and extend the scope of data
  standards for social care services
• Clinical Quality metrics develop measures of
  care outcomes, patient safety and patient
  experience
• Analysis and Measures of Care Activity
  mechanisms for assuring key indicators more
  patient-centred measures that reflect the
  movement of care from hospitals to primary and
  community settings.

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Syndication of Information Service
The Syndication Service is a central distribution
hub for data from across the health and social
care sector getting-processing-delivering
content.

• Syndication will
• Improve collation and distribution of data - not
  just from the NHS IC
• Create standardised and secure methods - data
  collected once, relayed to users in a safe,
  controlled and properly governed manner.
• Use Signposting and other technologies to tailor
  and automate dissemination.
• Benefits will come from
• Secure provision of information
• Effective governance protocols
• Equity of access and data usage (RUPSI
  compliance)
• Improved business processes

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Honest Broker Service
The Honest Broker Programme will establish an
Independent Compliance Unit and an Honest
Broker service providing the NHS and other
researchers with information to support their
needs.  

• Development of an IG Framework
• With the Research Capability Programme, and key
  stakeholders such as National Information
  Governance Board and the BMA.
• To establish standards to safeguard the
  confidentiality of patient level personal
  information while improving the capability of
  information providers.
• An independent IG Compliance Unit to
• Ensure adherence to the Framework
• Take ownership of the continuing maintenance of
  the Framework.
• The initial IG Framework and IG Compliance
  service will be delivered in April 2009 and be
  further developed through 2009/10.  

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Signposting of Information
Signposting will help information users identify
what information is available across the whole
health and social care landscape, and get hold of
that information.

• Signposting service will deliver
• New interactive, web resource (portal) for
  accessing health and social care information .
• Improved discoverability of health social
  care information within the NHS IC and other
  online resources, e.g. NHS Evidence, Social Care
  Institute for Excellence.
• Contextually-relevant user experience, providing
  appropriate links to information, and tools which
  help answer questions and business issues.

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Clinical Programmes
Focused on meeting the information needs of the
clinical community in the NHS and in supporting
the quality framework.

• The clinical program covers
• Care quality indicators leading on the
  development of new and existing indicators to
  bring clarity to quality and enable it to be
  measured.
• Population Health working with Public Health
  Observatories to drive forward the quality
  agenda.
• Clinical audit establishment of a new audit
  support service.
• Research creating a focal point for
  information to support clinical research.

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Indicator Framework
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Care Quality Indicators Assured Menu of
Indicators

• DH aiming to provide an assured menu as
• resource for local clinical teams usable as the
  basis for local quality improvement
• a source of indicators which can be used to
  benchmark between providers
• Initial sources
• Indicators well supported in IC CQI survey
  (report on www.ic.nhs.uk/cqi)
• SHA recommendations
• Royal College and Specialist Society responses
• Recognised indicator sets (Vital signs, HCC, WCC,
  QOF)
• Will have gaps - indicators will be added (
  removed) as they are developed
• Criteria for indicators
• clear evidence base
• clear, unambiguous definition
• robust calculation methodology (appropriately
  defined, standardised and risk-adjusted to avoid
  perverse incentives, gaming and
  misinterpretation)
• support from professionals

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Information for patients - NHS Choices Programme

• The NHS Choices website (launched in 2007) helps
  the public
• Find trusted answers on health and wellness
• Identify how local health services are performing
• See information about the quality of services.
• It underpins many of the reforms outlined in Lord
  Darzis review.

The NHS IC will be the definitive source of
quality data for the website as well as the
collaborative partner to identify and develop
patient relevant information

• Maintaining and developing Clinical Indicators
  with robust transparent methodology.
• Data Directories maintaining and developing -
  GPs, Pharmacies, Dentists, Health Services etc.
• Information and indicator development

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Information for Commissioning
A programme of work streams to provide relevant
information to support World Class Commissioning
(WCC).

• Joint Strategic Needs Assessments (JSNA).
• Update and extend the WCC data packs.
• Addressing data and metrics gaps.
• Information skills for commissioners.
• Supporting the information requirements of
  Practise Based Commissioning (PBC).
• Supporting Metrics development for the Nation
  Integrated Care Pathway Pilots.

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Commissioning Cycle
Social Care publications and statistics How much
is being spent on social care services locally?
Joint strategic needs assessment (JSNA) JSNA core
dataset focussing on a list of indicators,
cross-tabulated against Vital Signs and the
National Indicator Set.
Healthcare Resource Groups (HRGs) Supports
determining of service provision based on
measuring current and future treatments.
Neighbourhood Statistics Service Understand the
factors involved in reducing neighbourhood
deprivation levels.
Lifestyle Publications Insight into alcohol
consumption, obesity, smoking, drug misuse, and
specialist surveys relating to young people.
NHS Comparators Local in/outpatient disease area
activity, costs, outcomes, and identifying
prescribing activity.
Quality and Outcomes Framework Resourcing
healthcare based on practice-level prevalence
data.
Health Poverty Index Compare the indicators that
influence health inequalities between different
areas.
Health Survey for England Annual snapshot of the
nations health and health needs.
Hospital Episode Statistics (HES) Records of all
admissions to NHS hospitals in England.
Clinical Audit Compare clinical conditions and
treatment received for cancer, heart disease,
diabetes and renal services.
General Practice Dentistry Statistics providing
insight into earnings, expenses, levels and types
of activity
iView Workforce Online resource enabling NHS
workforce planning, using statistics on NHS staff
numbers, earnings, turnover, and vacancies.
Over 120 health and social care publications
Comprehensive insight into disability, older
people, child health and measurement, screening,
eye care, maternity, general practice, and mental
health.
http//www.ic.nhs.uk/commissioning
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Information for Social Care
A strategic national programme aimed at improving
the use of information to support adult care and
support services.

• Joint DH and Local Authority Strategy Board.
• More co-ordinated strategic approach to managing
  the growing number of projects/programmes which
  impact on adult care and support services.
• Refreshing the work around the electronic social
  care record with a stronger focus on data
  standards (including use of NHS number).
• A national informatics programme to align health
  and social care information
• Systems developments.

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Social Care Actions

• Implement the recommendations from NHS IC
  comprehensive review of adult social care
  collections, which will result in a significant
  reduction in burden for local authorities
• Make available the first phase of the development
  of a National Adult Social Care Intelligence
  Service (NASCIS) to modernise data collections
• Establish and manage the Strategic Improving
  Social Care Information Programme. Its role is to
  oversee the full range of projects which have a
  link to the information agenda.

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National Adult Social Care Information System
(NASCIS)
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Information for Workforce Planning and
Productivity

• Four strands
• Exploiting what we have
• Developing data standards to improve what we have
• Improving quality, completeness, timeliness
• Addressing the productivity question (i.e.
  links to activity and outcomes)

• Widening the data items available in iView
  workforce
• Monthly data on headcount and turnover along with
  the existing workforce numbers, earnings and
  sickness absence figures
• Engaging with NHS Jobs to exploit the data behind
  it
• Could monthly data on vacancies posted, filled,
  unfilled, number of applicants per position be
  available in a flexible iView format for analysis
  by job type, regional variation etc?

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Information for Finance and Performance

• The Department of Health is in the process of
  introducing a new NHS performance regime that
  covers
• Finance and performance
• Operational standards and targets
• Quality and safety
• User experience
• Board capability

• The NHS IC intends through its Director of
  Finance and Performance to take an active role in
  providing accurate and timely information to help
  deliver the agenda and by working closely with
  the Care Quality Commission and Monitor as
  regulators in this area.

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Core business, capacity and capability

• Three elements
• Information services and analysis.
• NHS IC Organisational Development Capacity.
• Building frontline information management
  capacity/professional development.

• Business as usual PQs, publications,
  indicators, standards, systems
• OD processes, standards, behaviours, programme
  management, CPD
• Practical support for frontline IM
• shared solutions to shared problems tools,
  information, guidance
• development - training materials, e-Learning,
• apprenticeships?
• NHS IC Associates scheme, etc.?

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