Integrated Care Record Service electronic records in the UK

1
Integrated Care Record Serviceelectronic records
in the UK

• David Young
• Information Policy Unit
• Department of Health

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Technological advance are supporting a paradigm
shift in care
3
Patient Centric NHS
4
Process is complex
NHS Core Information Services
5
www.
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National Programme for IT in the
NHSDelivering 21st Century ITSupport for the
NHS
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(No Transcript)
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ICRS - Overview

• The ICRS is the
• Integrated, operating across the care continuum
• Care, covering both health and social care
• Records, single record based around the patient
• Service, with corresponding service levels

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What is the purpose of ICRS ?
The purpose of ICRS is to support the provision
of high quality patient care across the whole
health community
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ROBUST NATIONAL INFRASTRUCTURE
National
Access
Network
Security
Directory
E-mail
Services
Control
1. Infrastructure Services
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WITH NATIONAL INFORMATION SERVICES
National
Access
Network
Reference
Security
E-mail
Directory
nhs.uk
NelH
Control
Files
Services
2. Information Services
1. Infrastructure Services
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INCREASING NUMBER OF NATIONAL APPLICATIONS
e-learning
Finance
Analytical
NHS Direct
e- commerce
Population
e-Staff
ETP
Services
CAS
.
Record
Record
3. Application Services
Access
Reference
E-mail
Security
nhs.uk
Directory
NeLH
Network
Control
Files
2. Information Services
1. Infrastructure Services
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LOCAL - GENERIC FUNCTIONS
Health Community
4. Generic Functions
Clinical Governance
Local
Knowledge Management
Digital Imaging
Services
Prescribing
Ordering and Reporting
Booking and Scheduling
Diagnosis and Care
Service User Index
e-learning
e- commerce
Finance
Analytical
NHS Direct
Population
e-Staff
ETP
.
Finance
Record
Services
CAS
Record
3. Application Services
National
Access
Reference
Nhs.uk
NeLH
Network
Security
Directory
E-mail
Services
Files
Control
2. Information Services
1. Infrastructure Services
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LOCAL - SPECIFIC FUNCTIONS
Health Community
6. Specific Functions
5. User
Environment
Information
Pathology
Mental Health
Acute Care
Social Care
Primary /
Community
Capture
Information
Reporting
4. Generic Functions
Local
Clinical Governance
Analysis
Knowledge Management
Services
Digital Imaging
Prescribing
User Tools
Ordering and Reporting
Booking and Scheduling
Information
Diagnosis and Care
Governance
Service User Index
e-learning
e- commerce
Finance
Analytical
NHS Direct
Population
e-Staff
ETP
.
Finance
Record
Services
CAS
Record
3. Application Services
National
Access
Services
Reference
Nhs.uk
NeLH
Network
Security
Directory
E-mail
Files
Control
2. Information Services
1. Infrastructure Services
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LOCAL - CLINICAL CONDITIONS
Health Community
6. Specific Functions
5. User
Environment
7.
NSFs
Information
Diabetes
Pathology
Mental Health
Acute Care
Social Care
Primary /
Community
Capture
Mental Health
Information
Reporting
4. Generic Functions
Older People
Local
Clinical Governance
Analysis
Knowledge Management
Cancer
Services
Digital Imaging
Prescribing
User Tools
CHD
Ordering and Reporting
Booking and Scheduling
Information
Etc.
Diagnosis and Care
Governance
Service User Index
Finance
e-learning
e- commerce
Analytical
NHS Direct
Population
e-Staff
ETP
.
Finance
Record
Services
CAS
Record
3. Application Services
National
Access
Reference
Services
Nhs.uk
NeLH
Network
Security
Directory
E-mail
Files
Control
2. Information Services
1. Infrastructure Services
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NATIONAL STANDARDS SUPPORTING LOCAL USERS
Health Community
6. Specific Functions
5. User
Environment
7.
NSFs
Information
Diabetes
Mental Health
Acute Care
Pathology
Social Care
Primary /
Community
Capture
Mental Health
Information
Reporting
Local
4. Generic Functions
Older People

• IT
• Information
• Governance

Clinical Governance
Analysis
Services
Knowledge Management
Cancer
Digital Imaging
Prescribing
User Tools
CHD
Ordering and Reporting
Booking and Scheduling
Information
Etc.
Diagnosis and Care
Governance
Service User Index
Standards
Finance
e-learning
e- commerce
Analytical
NHS Direct
Population
e-Staff
ETP
.
Finance
Record
Services
CAS
Record
3. Application Services
National
Services
Access
Reference
Nhs.uk
NeLH
Network
Security
Directory
E-mail
Files
Control
1. Infrastructure Services
2. Information Services
17
ACROSS HEALTH COMMUNITIES
Local
Services
Standards
National
Services
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The Electronic Social Care Record

• Mrs. Jones needs a visit

Letters
Audiovisual records
Social worker Case notes
E-mails
Computer records
Contact sheets
Visit schedules
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April 2002 - March 2003

• Infrastructure
• Define data standards
• Define interchange standards
• 100 Consultants with PCs
• Application services
• Create first stage of National Health Record
  Service
• Agree XML based EPR System Specification, using
  open standards
• Implementation and Support
• Work with OGC and e-Envoy to streamline
  procurement
• Begin increase of NHS IT capacity and capability

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April 2003 - December 2005

• Infrastructure
• Broadband access (gt128kbs) to every clinician
  support staff in the NHS, increased bandwidth to
  minimum - 2Mbps between trusts and across NHS Net
  Gateways
• Access and authentication available for all NHS
  staff, implementation of National NHS Directory
  Service
• Domain to domain encryption implemented

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January 2006 - December 2007

• Infrastructure
• Broadband access implemented at recommended
  access speeds across local and wide area networks
  in the NHS
• Secure access mechanisms (e.g Smartcards) for all
  NHS staff
• Application Services
• Full National Health Record Service, with core
  data and reference links to local EPR systems for
  full record access
• National Bookings Service, all patient
  appointments, implemented
• National Prescriptions Service, with full
  clinician and patient functionality, 100
  implemented

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ICRS will ensure

• Unified record for all types of care
• Patient access to own records
• Improve their knowledge
• Improve their involvement in treatment
• Access to knowledge promoted
• Aggregated data provide for management and
  clinical needs

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Reasons for the ICRS

• Modernisation of the NHS
• Improve ability to change and reform
• Changes in working and clinical practice
  facilitated
• Clinicians supported in delivering frontline
  care
• Patient experience improved

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Benefits of Patient Centric Record

• All patient data available or accessible
• Alerts, allergies, sensitivities found
• Data not duplicated
• Resolution of data conflicts
• Update of whole patient record

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Problems with Institutional records

• Paper records single, unstructured, disorganised,
  illegible
• Records hold only part of patient details
• Duplication of some data likely
• Inconsistencies possible
• Vital data may not be available
• Drug history , allergies
• Double counting of items
• All records not up to date
• Addresses

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Methods of Collecting Incidence/Prevalence data

• Surveys
• Cross sectional
• Panel or cohort
• Medical records
• Hospital
• General Practice
• Disease specific registers

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Survey data problems/solutions

• More exact diagnostic data leading more accurate
  incidence and prevalence measures
• Irrespective of the manifestation of the
  condition
• The patients understanding and knowledge
  irrelevant
• Patient characteristics in answering questions
  irrelevant
• Data always available (cf patients in hosptial)

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Survey Data - problems

• Not Good for conditions
• Relatively rare
• Acute
• Short duration illnesses
• High fatality

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Survey Data problems/solutions

• Cheaper then cohort studies
• Suitable for conditions outside hospitals
• Disease registers easier to set up and maintain.
• Bigger database on which to draw (hopefully the
  whole population). Not just GPs with computers
• Population characteristics available by counting
  records