What the NHS Care Records Service will mean for Primary Care

PRIMIS Partnerships For Progress March 2004

What the NHS Care Records Service will mean for Primary Care

Paul Charnley and Dr Mike Bainbridge

What the NHS Care Records Service will mean for Primary Care

Paul Charnley

Regional Implementation Director

North West and West Midlands Cluster

Overview of Presentation

NPfIT – Overview of the Programme

NHS CRS and Primary Care – Current thoughts from a Cluster

Practical Issues – the benefits in prospect and implementation issues that face us.

• Confidentiality and Security• Data quality • eBooking• Electronic Transfer of Prescriptions• Electronic requests and results• Change to patient centric records –

access and choice• Secondary uses - New GP Contract

Who is doing what?

NPfIT - Overall NHS project development and management on behalf of the DoH

NHS CRS Programme – Development of the Service and specialist input into NPfIT

Clusters – ‘Localised’ NHS implementation management within each of the 5 locations for all NPfIT programmes

NASP – Contractor: ‘BT’ – Delivering the National Aspects of the NHS Data ‘Spine’

LSP’s – Contracts awarded – Deliver the products to support the services within a cluster

Local IM&T – Including local CIO’s – support delivery directly to services, liaison between LSP’s and workforce

Will enable details of the key events of a persons healthcare history throughout their life to be;

● collected, stored & retrieved● made available at all times ● across the whole country ● to those with authority to view

A better use of information and communication technology within the

NHS would improve efficiency and cut costs

Wanless Report April 2002

Introduction – The NHS Care Record

NASP contract awarded to BT

Responsible for delivering nationwide aspects of NHS Care Record Service;

● NHS CRS Data Spine

● Secondary Uses Data warehouse

Main Data Spine components

● Transaction Messaging Service (TMS) - Manages messages in / out

● Personal Spine Information Service (PSIS) – Holds all clinical messages

● Personal Demographic Service (PDS) – Information for patient identification

NASP (National Application Service Provider)

Data

Messages

Processes/Logic

Applications

Other Links

Infrastructure/Services

Personal Demographic Service

Business continuity

and DR

Access and Control

Help Desk

Patients

Personal Spine Information Service

Spine Directory Service

Help Desk NHS

Transaction Messaging Service

Patient Details

eBooking

Clinical Messages

eTP

Patient Details

eBooking

Clinical Messages

eTP

Terminology Services

Workflow & Rules

Service

Links to ‘Health Space’

InterfacesLinks to Remote

Settings

Links to NationalServices

Clinical Applications

(View)

Secondary Uses Services

Replacement NWCS

Clinical Applications

(Input)

Data Quality &Data Quality

Management

NHS Care Record Spine – Components

The technical Infrastructure

LSP contracts awarded to

BT – London - IDX

Accenture – North East and East - iSoft

CSC – North West & West Midlands – iSoft

Fujitsu – South and South West - IDX

LSP (Local Service Provider)

Main Local NHS Care Record Service components (Core Bundles) (Different iSoft/IDX)

LSP (Local Service Provider)

1 Connectivity, Messaging and Access to PSIS and Spine Directory and eBooking Messaging

2 ICRS Set up and Basic Patient Administration within each Care Setting

3 Assessment & Clinical Documentation (including social care & elements of NSF's)

4 Clinical Support Services - Requesting & Order Communication, Decision Support and ePrescribing

5 Scheduling (including scheduling elements of NSF's)6 Integrated Care Pathways and Care Planning (including

elements of NSF's, e.g. CPA)

Main Local NHS Care Record Service components (Core Bundles) (Different iSoft/IDX)

LSP (Local Service Provider)

7 Maternity8 Information for Secondary purposes (including

elements of NSF's) 9 Emergency/Unscheduled Care10 Surgical Interventions11Alternative Options for GP's12 Prevention, screening, surveillance includes

elements of NSF's13 Ambulance

Main Local NHS Care Record Service components (Additional Bundles) (Different iSoft/IDX)

LSP (Local Service Provider)

• PACS and Medical Imaging• Radiology • Pathology• Financial Payments• eHealth• Document Management• Dental• Pharmacy Stock Control• Prevention, screening, surveillance• Social Care• Decision Support Advanced• Long term medical conditions

Patient IndexPACS

Prescribing &Pharmacy

Scheduling

ClinicalDocumentation

Request & OrderCommunication

Decision Support

Assessment

ResultsReporting

DocumentManagement

eBooking

Care Management

Care Pathways & Planning

User Tools

Prevention, scheduling

& surveillance

eBookingElectronic Transfer

Of Prescriptions

Personal Spine Information

Service(PSIS)

Personal Demographic

Service(PDS)

Transaction Messaging Service(TMS)

NASP

LSP

Service Components

Phasing - Overview

A phased delivery is necessary to;

● Meet NHS targets

NSF targets, e.g. SAP

● Facilitate delivery of a reliable stable national architecture

● Manage affordability

● Support an achievable delivery across the country

● Phase 1 Release 1 - June 2004 Release 2 – Dec 2004

● Phase 2 Release 1 - June 2005 Release 2 - June 2006

● Phase 3

December 2010

Phasing

Phase 1– Access to information– Passive, viewing of data– Implementation of specific

targets

Phases 2 and 3– Active support for care

provision– Order communications,

prescribing, scheduling– Full functionality

Technical Infrastructure – Expected Take-up

Total number of messages annually through Transaction Messaging Service

0

1,000,000,000

2,000,000,000

3,000,000,000

4,000,000,000

5,000,000,000

6,000,000,000

2004 2005 2006 2007 2008 2009 2010

Year

No

. o

f M

es

sa

ge

s

PMIP

Ebooking

ICRS

ETP

PMIP

EBS

NHS CRS

ETP

NASP

LSP

iSoft i.EPR / Lorenzo

SeeBeyond Integration Bus

EM

IS P

CS

Torex P

SE

InPractise V

ision

Niche

Cluster wide Data Repository

Portal

Solution Architecture

eBooking PDS PSIS eTP

Transaction Messaging Service

Wrapper

Local NCRS

Messages

Messages

eBooking PDS

PSIS eTP

Primary Care - Evolution and Choice

PrimaryCare

System

Practice

Local NCRS

Wrapper

PrimaryCare

System

Data Centre

Other LSP

Services

Local NCRS Local NCRS

Integrated Services

eBooking PDS

PSIS eTP

Migration and Choice

Lorenzo

? ? ?

Current SituationMultiple Practice Systems with a few bureaux

04-06Tactical Hosted Bureaux ServiceMessaging compliantNot all system types supportedNot all practices migrated

?

06 onwards - Strategic position Primary Care Solution part of the Integrated NHS Care Record Service

?

Impact on Primary Care

Primary Care has a rich history of successful electronic patient records development and use

● Standards (RFA)

● Registrations (IOS)

● Appointments

● Longitudinal record

● Support for prescribing

● Audit and NSFs

… more

Issues for Primary Care

● Records in Practice only

● Wider primary care may or may not have access

● Links to the rest of NHSResults Requests/Referrals Prescriptions

● New models of care – Tier2/ Intermediate/ GP with Special Interest

● Out of hours/ unscheduled care

● NHSNet constraints… more

● Confidentiality and Security

● Data quality

● eBooking

● Electronic Transfer of Prescriptions

● Electronic requests and results

● Change to patient centric records –access and choice

● Secondary uses - New GP Contract

Issues/Implementation

Information Governance 12 principal topics

• ICRS Data Sharing

• Patient Access

• Legitimate Relationships

• Sealed Envelopes

• Role Based Access Control

• Other Access Controls

• Audit Trails

• User Registration• User Authentication• Pseudonymisation

Service• Secure

Communications• Compliance

Information Governance

A balance of benefits versus risks

● Protecting patients’ concerns without imposing impossible burdens on care delivery

● Caldicott Guardian principles will govern all data usage

● Plans in-hand for healthcare information governance service

Security

● Password / smart-card protection

● Audit trail for all ‘transactions’ – traces computer, user, activities performed / data accessed

0203_01:32 Patient W. Nurse A – New Record

0203_01:32 Patient C. Nurse F – Medication

0203_01:33 Patient X. Doctor C – Test Result

0203_01:33 Patient X. Doctor C – Clinical Note

0203_01:33 Patient A. Patient A - Discharge

… more

0203_01:32 Patient W. Nurse A – New Record

0203_01:32 Patient C. Nurse F – Medication

0203_01:33 Patient X. Doctor C – Test Result

0203_01:33 Patient X. Doctor C – Clinical Note

0203_01:33 Patient A. Patient A - Discharge

Information Governance

Confidentiality

● Rigorous role-based access controls

● Patient choice - electronic sealed envelope for highly sensitive information (expected during Phase 2)

● Professional & employee codes of conduct to govern usage

Information sharing

● Based on protocols & legitimate care relationships

● Patients able to ‘opt-out’ of consent to share information externally (i.e. Social Services)

Data Quality

● Good work done by PRIMIS in this area

● Ensure data is “Fit” for purpose

● To build record gradually or complete it with “downloads”?

● Patient registers

● Summarized records

● Extending content e.g. additional members of the primary care team

● Use of NHS Number

eBooking

● For the benefits of patients

● Shift of tasks around the health communities

● First high profile implementation

● Starts small with early adopters and grows

● Longer term plans

● Within PCTs

● Integrated with scheduling and Integrated care pathways

0203_01:32 Patient W. Nurse A – New Record

0203_01:32 Patient C. Nurse F – Medication

0203_01:33 Patient X. Doctor C – Test Result

0203_01:33 Patient X. Doctor C – Clinical Note

0203_01:33 Patient A. Patient A - Discharge

Electronic Transfer of Prescriptions

● Underway but awaiting details of the new pharmacist contract

● Current manual process duplicates, introduces errors

● Repeat prescriptions

● Physical “token”

Electronic requests and results

● Efficiency and safety

● Reducing duplication

● Pathology results started will be included

● Other results scheduled for P1R2

● Requests – guidance and protocols

● Less error in processing the requests

Change to patient centric records –access and choice

Health economy

Care settings

Healthcare services

National Scope

Clusters

SHA

Local Health Community

Organisation

Secondary uses – e.g New GP Contract

Pseudonomysed data set for analysis

Clinical Network

Supporting Implementation

Your support is vital to make this happen –

You have the opportunity to;

● Be involved in a process that will truly modernise the NHS

● Make it happen successfully both locally and nationally

● Enhance the position of informatics as a profession

● Support the development of a unique clinical infrastructure

● Support the delivery of a service that will have real benefits for patient care