Electronic Health Records in the United Kingdom of Great Britain

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Electronic Health Records in the United Kingdom
of Great Britain Northern Ireland

• Lorraine Nicholson MIHM, MRSH, FHRIM,
• President of IFHRO,
• Chief Executive IHRIM,
• Independent Health Records Consultant

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The United Kingdom of Great Britain Northern
Ireland

• The UK is made up of the two countries of England
  and Scotland, the principality of Wales and the
  province of Northern Ireland.
• Total Population is 59.6 million people 
•          - England 49,805,700 (83.7 of total)
•          - Scotland 5,057,400 (8.5 of total)
•          - Wales 2,938,000 (4.9 of total)
•          - Northern Ireland 1,702,600 (2.9 of
  total)
• Each country has a National Health Service (NHS)
  and in Northern Ireland there is integrated
  health and social care.
• Each of the four countries has its own approach
  to the development and implementation of
  Electronic Health Records.

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National EHRs in England (1)

• NHS Care Records Service (NHS CRS), - key
  component of the National Programme for
  Information Technology (NPfIT), a 6.2 billion
  programme, which supports the delivery of the NHS
  Plan.
• "the world's biggest civil information
  technology programme".
• An individual electronic NHS Care Record every
  NHS patient in England by 2010 (2 years behind
  schedule)
• Parliamentary Inquiry in 2007 - estimates of the
  total cost of NpfIT ranged from 6.2 billion to
  20 billion at the time of the inquiry.

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National EHRs in England (2)

• NHS Number is fundamental to the NPfIT NHS CRS
• A national unique patient identifier (10 digit
  number) to enable sharing of patient information
  across the whole of the NHS in England safely,
  efficiently and accurately
• The Personal Demographics Service is the central,
  single source for patient demographic information
  in England
• The Personal Spine Information Service (PSIS) is
  the central database containing clinical records
  for each NHS patient.

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National EHRs in England (3)

• NHS Care Records Service will provide all 50
  million NHS patients with an individual
  electronic NHS Care Record
• For the first time in the 60 year history of the
  NHS, information about patients will be mobile,
  as patients ar
• will connect more than 30,000 GPs and 270 acute,
  community and mental health NHS trusts in a
  single, secure national system
• two elements to the NHS CRS Detailed Records
  (held locally) and the Summary Care Record (held
  nationally).

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National EHRs in England (4)

• The NHS CRS will enable each person's detailed
  records to be securely shared between different
  parts of the local NHS e.g. GP surgery and
  hospital.
• Patients will also be able to have a summary of
  their important health information, known as
  their Summary Care Record, available to
  authorised NHS staff treating them anywhere in
  the NHS in England.
• Patients will also be able to access their
  Summary Care Record using the secure website
  HealthSpace.

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National EHRs in Wales (1)

• The NHS in Wales is large and complex
• Over 10 million face-to-face healthcare events
  per annum
• Care delivered by a wide range of national,
  local, statutory, contractor and voluntary
  organisations
• High levels of deprivation, an increasingly
  elderly population and poor lifestyle
• Has an annual budget of approximately 3.1
  billion
• Wales needs a modern healthcare system with
  services integrated around the patient.

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National EHRs in Wales (2)

• Informing Healthcare (IHC) is a Welsh Assembly
  Government programme set up to improve health
  services in Wales by introducing new ways of
  accessing, using and storing information
• IHC is working with NHS medical staff and
  consulting with the public to develop a national
  electronic health record the Individual Health
  Record (IHR)
• Secure web page - My Health Online to view
  medical history, order prescriptions, book
  appointments

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National EHRs in Wales (3)

• NHS in Wales cannot achieve a single universal
  care record immediately - therefore adopted a
  flexible incremental strategy

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National EHRs in Wales (4)

• Wales shares demographic services with England
• NHS number is the unique identifier to provide a
  unique patient identifier for the Individual
  Health Record
• Phased migration of all demographic systems to
  replacement systems provided by England's new
  Personal Spine Information Service (PSIS), which
  is part of the NHS Care Records Service (NHS CRS)
  
• Negotiating with the NPfIT in England to use
  selected services including allocation of NHS
  numbers

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National EHRs in Scotland (1)

• Modernisation strategy Delivering for Health
  focuses on the EHR as a core feature in
  delivering pro-active care to the population of
  Scotland
• Health Information System built around the EHR
  will facilitate a shift from the current care
  model to anticipatory, preventative and
  continuous care.

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National EHRs in Scotland (2)

• The Community Health Index (CHI) is a population
  register used in Scotland for health care
  purposes
• The CHI number uniquely identifies a person on
  the index - Scottish equivalent of the NHS number
  in England and Wales
• The CHI number is the unique patient identifier
  throughout the NHS in Scotland

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National EHRs in Scotland (3)

• Scotland and Northern Ireland have recently
  issued a joint tender to purchase a patient
  management system, with rich clinical
  functionality, worth between 30-120m over four
  years
• Possible pilot sites - NHS Ayrshire and Arran,
  NHS Borders, NHS Greater Glasgow and Clyde, NHS
  Grampian and NHS Lanarkshire (all Scottish health
  boards)
• After piloting system will be made available to
  all health service organisations in Scotland and
  health and social services organisations in
  Northern Ireland

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National EHRs in Northern Ireland

• Joint tender with Scotland
• Population of 1.8 million people
• Integrated Health and Social Services
• Unique, very manageable and compact centralised
  organisation
• Single Health and Care Number (equivalent of the
  NHS Number) to provide a unique identifier for
  national Electronic Health Records

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In Summary

• All four home countries are working actively
  towards national EHRs
• Each country has its own approach to development
  and implementation
• All are using a unique identifier for each
  patient
• The next four years will see considerable changes
  nationwide in the UK

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Questions?
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Contact Details

• Lorraine Nicholson
• l.nicholson_at_zen.co.uk
• Tel Fax [phone]
• Mobile [phone]