NHS INFORMATION STANDARDS BOARD

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NHS INFORMATION STANDARDS BOARD

• INDUCTION DAY 8TH JUNE 2005

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Martin Severs
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NHS INFORMATION STANDARDS BOARD

• INDUCTION DAY
• Professor Martin Severs

Martin Severs 8 June 2005
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Plan of the Day

• Welcome and introductions MPS
• Aims of the day MPS
• ISB vision strategy structure governance and
  important policies MPS
• ISB operational processes JM
• Assurance and appraisal a session led by RP
  including PW, AC, JM
• Lunch

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Plan of the Day

• The role of the reference group and its members
  BF
• Freedom of Information Act ER
• The Electronic Workflow System SP
• The Web site EL and SJ
• Closing Remarks MPS

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Aims of the Day

• Enable new and potential members to meet each
  other,ISB experts and ISB officers in a convivial
  and relaxed setting
• Gain clarity and understanding of what ISB does
  and how it fits in to the big picture
• Assess my/your contribution and learning needs in
  the overall effort
• Attain enough knowledge to feel comfortable that
  I/you can engage in effective participation

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Background What are standards?

• Standards have two different theoretical bases
• Document describing the properties of a good at
  national and/or international level
• Qualities, measures, performance or other
  attributes of a good to which others should
  conform at national or international level
• In the NHS the second is the chosen theoretical
  base and it has set up a number of mechanisms for
  assessing conformance for example the Health Care
  Commission

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Standards influence every thing we do!

• Standards are a fundamental building block for
  the economy and society
• Standards have always been key to manufacturing
  and trade
• Standards are increasingly applied to management,
  services, health, safety and the environment
• National Standardisation Strategic Framework
  DTI,CBI, BSI

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Why are standards important?

• Help disseminate technologies and best practice
• Contribute to economic performance eg about 1
  of annual growth may be from standards based
  activity
• Define key features of business concerned with
  product or service performance, safety,
  reliability and quality.
• National Standardisation Strategic Framework
  DTI,CBI, BSI

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What is standardisation?

• Establishing and applying a set of agreed
  solutions intended for repeated application,
  directed at benefits for stakeholders and
  balancing their diverse interests
• Involves all interested parties as participants
• Does involve conformity assessment testing,
  certification, and accreditation
• National Standardisation Strategic Framework
  DTI,CBI, BSI

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Background What Are NHS Information Standards?

• NHS Information Standards are information and
  communication technologies which achieve
  interoperability between independent computer
  systems functional interoperability and between
  independent users particularly patients,
  clinicians, and managers semantic
  interoperability in the NHS its communication
  partners

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Background What are the implications for the
DH/NHS of information standards?

• In order to conform the NHS/DH has to incorporate
  implementation guidance at the technical,
  organisational and human staff level with every
  IS
• There is a tension which needs to be managed
  between the technical, user and organisational
  components as equals
• There is an explicit link between information
  standards and those that monitor them through
  conformance criteria eg Regulatory bodies,
  Healthcare Commission, system accreditation etc
• Information standards explicitly reduce the
  degrees of freedom in order to produce greater
  gains in productivity, safety, cost, and
  hopefully effectiveness

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So what products should be demonstrable in any
information standard?
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I.S. Products for Assurance
Requirement
Specification
Organisational I.G.
Conformance Criteria
Technical I.G.
Conformance Criteria
Clinical/User I.G.
Conformance Criteria
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Vision of NHS Information Standards Board

• To provide an independent view of the proposed
  NHS Information Standards and their application
  with responsibility and accountability to assure
  their implementability, patient safety and
  interoperability.
• Gordon Hextall Chief Operating Officer NHS
  Connecting for Health

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Strategy NHS Information Standards Board

• Approve standards based on recommendations from
  an appraisal process
• Scope is the NHS in the UK including partner
  organisations which communicate with it i.e. Does
  involve social services
• Manage, commission and respond to reviews of
  existing information standards
• Contribute to policy and strategy around
  information standards
• Identify gaps and make recommendations to the
  NPfIT Programme Board chairman

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Appraisal

• Appraisal is the process of establishing the
  value and quality of proposed information
  standards
• Appraisal uses explicit tools and judgement of
  domain experts
• Appraisal considers evidence from implementation
  evaluation
• Appraisal is a QA tool

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Information Standards Board Strategy

• To undertake critical appraisals of submitted
  standards and provide recommendations to the
  information standards board
• To ensure all standards submitted for approval
  have undergone wide consultation and are
  supported for implementation in the NHS
• To ensure clinical, management and technical
  perspectives are fully represented

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Essentials of an Information Standard

• Focused on implementation in integrated
  electronic systems
• Appropriate for the needs of the NHS at a
  national level
• Safe for patients
• Timely
• Effective
• Economically viable
• Guidance for elements of implementation

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Types Of Standard

• Framework - A high level, over arching structure
  from within which standards at other levels can
  be derived and developed
• Fundamental - A standard that encompasses many
  distinct areas and will have multiple
  instantiations of operational standards. It is
  approved at full standard once operational
  instantiations have been demonstrated as agreed
  at draft standard stage
• Operational Standards - Detailed and precisely
  defined standard for operational use within
  specific areas of the NHS

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Where does ISB sit in respect to the NPfIT
Programme Board?
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NPfIT - Three tier governance accountability
Formal decision making and escalation
Departmental Management Board
Ministerial Oversight
National Programme Board
Supplier Boards
Advisory Boards

• CRDB
• ISB

Project Boards
Supplier Boards
Project Boards
Programme Boards
Supplier Boards
Project Boards
Supplier Boards
Programme Boards
Cluster Programme Boards
Project Programme Boards

• SHAs
• Trusts

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Proposals being worked through Assurance and
sign-off
Information Standards Project from design to
development to implementation
ISB Link Person
ISB Appraisal Group
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Proposals being worked through Assurance and
sign-off

• The ISB link person is the most suitable domain
  manager or assistant domain manager
• He/she attends all project meetings and
  continuously briefs appraisal group and workflow
  manager
• The ISB appraisal group is
• Chaired and led by a domain lead
• One member from each reference group
• The link person
• At least one other ISB member

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Proposals being worked through Assurance and
sign-off

• Appraisal Group outputs same as current ISAB
  outputs except
• Resolution would be expected to have occurred
  during normal development through Link or through
  escalation to domain lead
• Appraisal Group outputs would have improved the
  information standard during design and
  development and added value
• Timescales more likely to be met
• Would not need a formal full advisory board
  meeting to achieve

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New ISB membership

• Domain Leads 6
• National Patient Safety Agency
• Healthcare Commission
• Design Authority
• Information Centre
• Chairman of ISB
• Operational Director ISB
• PIAG

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Proposals being worked through Impact on ISB
membership

• Chief Information Officers Group
• Regulatory Bodies
• 1.      General Medical Council
• 2.      Nursing and Midwifery Council
• 3.      General Dental Council
• 4.      Health Professions Council
• 5.      Royal Pharmaceutical Society of GB
• 6. General Social Care Council

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Proposals being worked through Impact on ISB
observers

• a.      Scotland 1
• b.     Northern Ireland 1
• c.      Wales 1
• d.     Eire 1
• e.      Presenting Link Person 1
• f.       Developer/Sponsor if desired 1
• g. Care Records Development Board 1
• For specified items only
• As requested

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Jane Millar
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NHS INFORMATION STANDARDS BOARD

• Who, what and how of ISB operational working!

Jane Millar 8 June 2005
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What Im covering (but ask!)

• Location v independence
• Team members and their roles
• Overarching aims of team
• Recruiting and retaining reference group members
• Focus of Information Standards assurance
• Types and stages of standards
• Detail of the operational standard
• Key relevant submission requirements
• Managing our communications

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Location v Independence

• Currently - mixed economy centrally and within
  NHS
• Future fixed centrally (Leeds) and within NHS
• Separate email and web addresses

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Team members and roles

• Chairman
• Operational director
• Domain leads
• Domain managers/link persons
• Knowledge manager
• Office manager
• Administrator

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Overarching aims of team with standards

• Blood hounds!
• Understanding the complexity of the NHS world
• Input knowledge in specialist areas
• Engagement with developers and sponsors
• Establishing timescales
• Linking to reference groups
• Establishing and working with appraisal teams
• Authoring and processing of documents
• Communication to the world and identifying silos

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Proposals being implemented from 01.04.05

• Expand the domains of assurance in order to
  harmonise the process from 3 to 6
• The six domains are
• Clinical
• Technical
• Organisational
• Population and Statistics
• Social Care
• Security and Confidentiality

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Proposals being worked through new domains and
discussions

• Technical
• Statistics and Population
• Organisational
• Security and Confidentiality
• Social Care
• Clinical

• Technical assurance NPfIT and e-GIF
• Integration of ROCR and IC into ISB completing
• Data Definitions Group integration completing
• PIAG, SCAG, and Information Governance not
  resolved
• Local Government Standards Board integration
  completing GSCC
• Regulators and NPSA integration complete

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Recruiting and retaining reference group members

• Reference group draws in information standards
  experts from each of 6 areas
• Appraisal teams consist of mixed skill sets from
  ref group
• Not representative this is on ISB
• Based on recommendations, not open advert
• Evaluation of CVs against a job description for
  each domain
• Skills audit
• Serve 2 years on SLA with employing body or
  contract (potentially renewable)
• 30 days per year as maximum, 1 month notice
  either way!
• Undertake minimum of 3 appraisals
• Annual review of performance, identifying
  education needs and better ways of working

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Information Standards Assurance

• Identify
• Contact
• Continuous assurance
• Appraisal
• Sign off
• Change management
• Review

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Types of Standards

• Framework Standard a top-level structure that
  provides the NHS with a strategic technical
  direction to enable delivery of the information
  agenda. The Framework is not specific to an
  individual application or information standard,
  but sets the technical framework for the NHS and
  vendor community to work within
• Fundamental Standard a specific type of
  standard required for functional interoperability
  i.e. machine-to-machine automatic working for
  specific functions or purposes.
• Operational Standard supports the business of
  the NHS on a national scale and therefore
  intimately connected to the data and information
  concerned with direct patient care.

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Stages of standard

• Requirement
• Draft
• Full
• Change
• Review

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Operational Requirement

• There must be a clear strategic statement of need
  in the NHS
• And an explicit Technical Office agreement of
  integration with the NHS business architecture
• Indication that the sponsor/developer have
  considered existing or highly developed
  international standards which might
  preferentially be assessed and utilised
• Development Plan to take the work forward
• All submissions must provide written support from
  the sponsor and appropriate groups who will use
  the standard, including Royal Colleges.

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Operational Draft Standard

• Agreed requirement and hard evidence of
  implementability from sandpit and model 1,2 or 3
  testing as agreed with Technical Office of NPfIT
• Must include
• Specification
• Technical Implementation Guidance
• Human Behavioural Guidance
• Organisational Implementation Guidance
• Conformance Tests

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Operational Standard

• Approved draft standard
• Complete implementation across 1 LSP, NASP or
  NISP with evidence of fitness for purpose
  provided by the NHS and partners
• Must include a final
• Specification
• Technical Implementation Guidance
• Human Behavioural Guidance
• Organisational Implementation Guidance
• Conformance Tests

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Key relevant submission requirements

• Security and confidentiality
• Ownership of the standard
• Licensing issues.
• Process for maintaining and updating
• Human behavioural guidance must consider and make
  recommendations on
• Collection of data
• Quality assurance of the data
• Processing of the data
• Organisational and cultural issues
• Contractual issues for staff
• Skill mix changes in organisation
• Undergraduate education and development
• Postgraduate education and development

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Openness

• Publish Decisions, Policies and Procedures
• Publish appraisal tools
• Publish NHS Approved Information Standards
  directly or indirectly
• Advertise for all funded post
• Wide membership of Boards

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Information for Standards Users

• Use of Standards Grid on ISB website to notify
  standards users of standards in process of
  appraisal
• Publication on ISB Standards Grid of Output,
  Standards and Guidance's to support
  implementation
• A web-based, searchable Information Standards
  Resource
• Glossary of Terms
• Links to relevant organisations and bodies
• Knowledge manager function to help with any
  information enquiries and input to development

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NHS INFORMATION STANDARDS BOARD

• Process of Assurance and Appraisal

Richard Popplewell 8 June 2005
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A Little History

• Breadth of NHS perspective with focus on
  submission
• Rigour with common sense
• Supportive but enquiring
• Make best use of skills and experiences
• Success is an improved and satisfactory standard
• Currently on third way of conducting appraisals

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The First Way

• ISB Relatively small decision making group
• 3 ISB Domains
• Management ISB
• Technical ISB
• Clinical ISB
• 3 groups run simultaneously
• Cross conversations between Domain leads/staff
• Dilemmas/differences resolved at ISB

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The Second Way

• ISB Relatively small decision making group
• Large IS Advisory Group (ISAB)
• Lead appraiser approach with submitter presenting
  and answering questions
• Most members have non-involvement in ISAB
  processes for specific submissions

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The Third Way

• ISB Relatively small decision making group
• Purposively formed small appraisal groups
  representing different domains
• Domain lead/manager identified
• More supportive and interactive with developers

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Pam Westley
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NHS INFORMATION STANDARDS BOARD

• Reflections on leading an ISB Appraisal for the
  first time

Pam Westley 8 June 2005
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Context

• Sexual Health Dataset
• Requirement for a standard
• Appraisal led by Statistics and Public Domain
• Formal appraisal yesterday
• Personal reflections on very recent events

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Beforehand

• Some trepidation for the first one
• Sexual Health sounds tricky and sensitive!
• Will I get confused over what is a requirement
  and a draft ?
• What about the famed ISB paperwork?
• The process
• Submission received
• Appraisers recruited
• Template for appraisal sent and returned
  completed
• Responses collated, summary of issues produced
• Formal appraisal session arranged
• All paperwork sent to all participants i.e.
  appraisers, submitters, and
• support team
• The appraisal day dawned!

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During

• Pre-meeting of team to confirm format issues
• Submitters arrived and a start made
• A rich and varied discussion followed. It
  covered
• Specific issues raised by the appraisers
• Sharing the more detailed thinking which had
  happened since the submission
• Some really intricate and important ethical
  professional issues
• Sharing of experience and knowledge of the group
  to help progress this work
• Development of tangible ways forward to meet
  requirements for APPROVAL and future ASSURANCE
• Short term actions for next ISB
• Positive feedback from the submitters about the
  meeting
• Post meeting summary, stocktake and document

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Afterwards-reflections

• Yes, sexual health is a tricky and sensitive
  area-all the more interesting and important to
  get it right
• I am much clearer about the distinction between
  requirements (why it needs to be done) and draft
  (how it is going to do it) standards
• The famed paperwork made it EASIER (for me at
  least!)
• But I couldnt have done it without
• The support team co-ordinating, chasing,
  analysing preparing the information
• The appraisers who provided detailed and
  thoughtful evaluation recommendations
• The submitters who were keen to develop a robust
  and relevant standard
• Overall, I enjoyed it and learned a lot, and
  looking forward to the next stage

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Anne Casey
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Appraisal criteria

• Clear statement of what it is /what its for
• Evidence about process consultation,
  development, testing ..
• Sufficient evidence of fitness for purpose
• Sensible implementable, not duplicating..

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My way of working

• Make sense of the submission
• Confirm the evidence
• Google, Scotland, Pubmed (CEN/ISO)
• Networks and/or local contact
• Appraise and recommend next stage action

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Small appraisal groups

• ? more focused
• ? better dialogue
• ? team working
• ? learning / growth

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More focused but

• Work expands to fit the time available
• Tools and guidance improvements
• Objectivity
• Less is more e.g.
• Less implementation stuff at requirement stage
• Exemplar performance characteristics (and
  criteria for appraising draft submissions) for
  different kinds of standards
• Exemplar users / uses specification (and
  requirements for draft evidence) for different
  kinds of standards (e.g. outputs for datasets)
• Datasets fit for purpose not just collectable!

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Better dialogue .. but

• Potential for formative approach needs more
  work
• Follow-up process timescales
• Time commitments

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Team working but..

• What else? By whom? Clinical????????
• 1 page / 5 minute update (push web for pull)
• Appraiser selection (later today?)
• Comparable rigour? back to objectivity
• Cross fertilisation
• ?

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Learning growth personal, new members, ISB
system

• Developments (NHS UK Standards ..)
• Horizon scanning
• Process improvements / rigour, objectivity
• ???. I dont know what I dont know

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Brian Footitt
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NHS INFORMATION STANDARDS BOARD

• ROLE OF THE REFERENCE GROUPS

Brian Footitt 8 June 2005
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Specialist domains

• Clinical
• Management
• Technical
• Security Confidentiality
• Social Care
• Statistics Public Health

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Skills Knowledge

• Appreciation of NHS Connecting for Health
• Clinical Audit Research
• Information Clinical Governance
• Good written/verbal communication skills
• Internet technologies
• Willingness and ability to travel
• Clinical Standards Development
• Critical appraisal skills
• NHS Connecting for Health adopted technologies
  Solutions
• Application system design record architecture

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Skills Knowledge - 2

• Clinical record keeping communication
• System implementation support in a health and
  social care setting
• Telecommunications wireless technology
  standards
• System security
• The interface between Patient Safety
  information standards
• Clinical Processes Procedures
• Patient Safety in Clinical care
• Government technical (framework) standards
• Clinical Terms such as READ, SNOMED
• Health/Social care process and systems interface

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Commitment

• Information Standards Board team
• Timely/relevant information/communications
• Resource KM, ongoing educations, link manager
• Domain, office, leads
• Members of the Reference Group
• Timeliness, confidentiality, multi-disciplinary
  working, travel/electronic, communication
• Minimum 3 standards, up to 30 days per annum
• Come to recommendations

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Education and development

• The NPfIT HL7 messaging programme
• Technology Office QA session
• Presentation on Bar Coding Technologies
• HL7
• Health Language and terminology tooling
• Record Architecture Paper
• Document Management standards

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Education and development - 2

• Future sessions
• Actual and contributions from the group
  themselves and suggesting

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Emily Ryder
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NHS INFORMATION STANDARDS BOARD

• Freedom of Information Act how it affects you

Emily Ryder 8 June 2005
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Background to FOI Act

• Came into Force January 1 2005
• Applies to any information held by Public
  Authorities
• Gives anyone the right to request information
  that is held as part of the Public Record
• Organisation can only refuse if an FOI exemption
  applies
• The spirit of the Act is to always provide
  information unless there is very good reason.

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Principles

• ISB adheres to the FOI policy set out by DH
• Any information generated during business for ISB
  forms part of the record
• E-mails do not need to be kept unless they have
  key decisions in them or information that may
  impact on a key decision
• Consider all information produced as part of ISB
  business as potentially going out into the public
  domain.

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What to do next

• Requests must be made in writing, if any come to
  you pass to your domain manager who will
  co-ordinate with ISB FOI Lead ( Brian Footitt)
• Keep e-mails that have important advice or
  decisions on them
• Please respond to FOI requests for information
  from ISB as quickly as possible, we have 20 days
  total to respond and refer to DH if necessary.

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Steve Phelps
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NHS INFORMATION STANDARDS BOARD

• Managing standards using a formal workflow system
  -
• what it means for you

Steve Phelps 8 June 2005
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WHY DO WE NEED AN ELECTRONIC SYSTEM?

• To handle growing complexity
• Management Reporting
• Future Planning
• Current Activity Monitoring
• Audit Trail Availability
• Integration with NHS Connecting for Health

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WHAT WILL IT BE LIKE?

• Components
• Stage summary sheet per standard
• Workflow tasks (integrated to e-mail)
• Documents Record
• Initial Responsibilities
• ISB Team only - get task done
• Future Responsibilities
• All ISB participants.
• Full integration with CfH systems (FileCM)

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NHS INFORMATION STANDARDS BOARD
www.isb.nhs.uk
Ed Lacey / Sarah Jones 8 June 2005
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Website

• One stop shop for all information about whats
  going on in ISB
• Contact information
• Publishing of documents
• ISB Papers e.g Approved minutes
• Policies Procedures
• Support Tool

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What we would like you to do!

• Look here first for ISB publications papers
• Provide us with feedback on content
  functionality
• Visit site regularly
• Demo of the site