TARGET 9/6/04

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TARGET 9/6/04 The NPfIT and You

• (Information and Technology Solutions Assessing
  and addressing your own and the teams IT needs.)

Dr Phil Griffin (IMT Clinical Lead)
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Who Said This?

• By 2010, every NHS patient in England will have
  an individualelectronic NHS Care Record

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A Brief History of Time

• Pre-1997 The Dark Ages
• 1997 All Change
• 1998 Information For Health
• 2001 Building the Information Core
• 2002 The Wanless Report
• More money. Lots more money
• Central management of a National Programme
• 2002 - Delivering 21st Century IT Support for the
  NHS
• 2003 The National Programme for IT is born and
  History starts
• 2004 Clusters are born and a DOCTOR gets
  involved!

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WHAT DO THE FOLLOWING HAVE IN COMMON?

• 265,000
• NPfIT

Richard Granger
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Acronym Assassination

• DONT say EPR
• DONT say EHR
• DONT talk about the HRI
• Only say IfH if youre really old
• Forget ICRS (as of 2/12/03)
• If youre hip and happenin, say
• NHS Care Record Service

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NPfIT

• A 2.3bn programme over three years to deliver
  four key elements
• NHS Care Records Service
• Electronic appointment booking
• Electronic Transmission of Prescriptions
• Underpinning IT Infrastructure (N3)
• Best use to be made of the existing asset base
• NPfIT is about patients and those who care
• for them, not technology

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NPfIT Basic Structure

• The design and roll-out of the NHS Care Records
  Service has been organised into two parts
• Services that are common to all users nationally
  will be the responsibility of the National
  Application Service Provider (NASP).
• Services delivered at a more local level will be
  the responsibility of five Local Service
  Providers (LSPs).

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LSP Clusters
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Phase 1 - by end 2004

• Booking of outpatient appointments online
• NHS email and access to online knowledge
• Electronic laboratory and radiology results
• Some clinical communications e.g. GP referral
  letters
• Basic spine functionality
• Providing simple functionality and
• making best use of existing systems

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Phase 2 - by end 2006

• Access to a more detailed patient record
  including
• specialist results
• GP prescribing record
• hospital discharge summaries
• Digital imaging
• Computerised referrals and requests
• Migrating on to active and interactive
  functionality

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Phase 3 - by end 2008 and continuing

• Working towards full integration of health and
  social services including
• decision support software
• screening
• community wide prescribing
• computer support for care planning
• Supporting advanced features e.g. telemedicine
• Continuing development and enhancements

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The Care Record Service

• A mix of local and national IT services proving a
  cradle-to-grave NHS Care Record.
• Summary patient record personal health
  information and demographic data
• The Spine

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The Care Record Service

• Applications at a local level provided by Local
  service Providers (LSP)
• Accenture (930 million)
• Common national applications provided by National
  Application Service Providers (NASP)
• BT (620 million)

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The Care Record Service

• The NASP will provide software and support for
  summary patient record, and implement consistent
  security and confidentiality principles.
• A Transaction Messaging System (TMS) and an
  Access Control Service (ACS)

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The Care Record Service

• The Local Service Provider (Accenture) will act
  as system integrators, supplier managers and
  programme managers for the clusters
• They will ensure systems are spine-compliant and
  deliver hardware and software replacements and
  implement core local training

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Got it? If not, just remember

• The Care Record Service is a really, really GOOD
  IDEA.

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E-Booking (oh no!)

• Choice is a main driver behind eBooking
• Patients will choose from a number of options
  including which hospital, and when, they would
  like to attend
• Booking will be made at point of referral
• OR
• Later on through a Booking Management Service
  (BMS)

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E-Booking

• Contract with Atos Origin
• First bookings this year, then six phases
• All surgeries by Dec 2005

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Three Other Things

• Electronic Transfer of Prescriptions
• N3 bigger, faster, better
• NHSmail a lifelong secure email address for all
  NHS staff.
• So email me at phil.griffin_at_nhs.net

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The Bluffers Guide to the National Programme

• Know the 4 areas NHSCRS, eTP, e-Booking,
  Infrastructure
• NPfIT En Pee fit
• Remember the small f or lose all street cred
• Practice saying LSP clusters and remember East
  Midlands and East of England. (Forget the rest)
• Mug up on Accenture
• Express enormous sympathy to any Celtic friends
• Ask you colleagues if their systems are
  spine-compliant
• Say NHS Care Record Service a lot, especially
  in meetings
• Let as many people as possible know youve got an
  NHSmail address and actually use it

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What does this mean for General Practice?

• the LSP
• Phased introduction of new solution over few
  years
• Spine compliant
• Central servers
• Info across N3
• Data exchange with acute trust/community clinics
  etc support SAP

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What does this mean for General Practice?

• Choice of solution between two (nGMS says three)
• Second TBA by October
• In theory no compulsion to change. BUT
• Contract also states no loss of functionality
• BMA Guidance

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So Whats Going On Locally?

• The SHA has control
• The Chief Information Officer is therefore a Very
  Important Person (Mike OBrien)
• The LIS Project evolved and perished
• ISSGs (4 quadrants 1 SHA)
• The Herts Health Informatics Service (HHIS) is
  expanding and evolving
• June Dodds is our Project Manager
• No GPs want to join in yet

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Even More Locally

• We have 14 Practices
• 9 EMIS
• 3 IPS
• 1 Torex
• Some are paperless
• We have numerous scattered community sites, some
  poorly connected
• NSF-driven PCT initiatives especially CHD
• All main GP surgeries are on the NHSNet
• All have pathology messaging
• We have an IMT manager and a Data Quality
  Facilitator (Assorted Roz/ss)
• Our PCT IMT Strategy is done
• Our Data Quality Strategy is done
• Our IMT Committee meets regularly and with
  Hertsmere
• We have strong links with the SHA ISSG
• We have implemented Network Managed Services

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What Have We Got To Do?

• Increase funding earmarked for IMT
• Get the Community staff and branch surgeries
  connected
• PCT ownership and full funding of Primary Care
  IMT
• Convergence of Primary Care data quality
• PCT-wide standard auditing
• Move away from practice-based servers
• Evolution towards the Care Record Service in
  co-operation with our LSP
• Development and enhancement of support and
  maintenance

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OK HOW???

• Invest
• PCT-wide standards in Information Governance
• Work with the HHIS on the community and branch
  surgery networking
• Expand Network Managed Services to all PCT
  practices, along with other PCTs
• MSD Audit Tool
• Data Quality Strategy
• Training
• Understand the New GMS Contract

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A Vision of the Future

• Money. Lots and lots of money
• A true broadband NHSnet infrastructure
• Standardised medical record coding across the NHS
• All clinicians have access to the information
  they need to know
• Practices free to use whichever front-end they
  like, from a nationally approved list
• Standardised note summarisation
• Patient record held in Primary Care and on the
  Spine
• Messaging in from secondary care
• GP to GP transfer seamless and 100 via the
  Spine
• Web-based access to medical records for patients
  and health professionals
• Many web-based services for patients
• GPs able to web-access secondary care databases
  and vice versa
• E-everything booking, prescribing etc.

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Will It Work?

• There is a real need
• There is real central strong drive
• There is available funding
• The benefits are almost incalculable
• Theres political will, possibly motivated by
• a General Election

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Director General of NHS IT, Richard Granger
said"Patients will see a modern, IT-enabled
NHS, every time they come into contact with the
service. They will benefit from
coordinated,convenient and integrated care that
places them at the heart of the NHS.
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For Coalface Clinicians

• Proceed to paperless record keeping
• Use the new GMS QOF to improve your coding
• Consistent data recording across the practice
• Information Governance

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Information Governance

• How does the practice handle, share and secure
  confidential information?
• Caldicott Guardian
• Written protocols
• Staff training
• Audit and review
• Use the toolkit