National Programme for Information Technology, London, 2004. All
rights reserved. British Computer Society The Care Record Service
and Information Governance functions Stephen Elgar 14 th March 2006
Slide 2 National Programme for Information Technology, London,
2004. All rights reserved. Introduction The Care Record Service
what is it? Where have we got to in London? Information Governance
functions / tools that underpin the Care Record Service Experience
in use of these tools Active Information Governance controversies
Slide 3 National Programme for Information Technology, London,
2004. All rights reserved. Slide 4 Slide 5 The future: Eldorna
Smith Eldorna (65) has a fall. Her neighbour discovers her in the
evening and calls an ambulance. Slide 6 National Programme for
Information Technology, London, 2004. All rights reserved. The
ambulance crew uses a protocol of tests that show a minor infection
could be making her unsteady. They rule out broken bones and check
her electronic health record with her for other potential causes.
Slide 7 National Programme for Information Technology, London,
2004. All rights reserved. Eldorna doesnt want to go to hospital.
The crew consult a doctor in the A&E via telelink. The doctor
agrees the diagnosis and sends a prescription electronically that
the local pharmacist will deliver with clear instructions. It has
been checked against Eldornas other medications. Slide 8 National
Programme for Information Technology, London, 2004. All rights
reserved. At Eldornas request, the crew book an assessment by the
intermediate care team, who will visit within two hours and arrange
home services. At her request, they also book a follow up
appointment with her GP at a time that suits her. They do this
online as the surgery is closed. The GP will get a prompt if she
doesnt attend. Slide 9 National Programme for Information
Technology, London, 2004. All rights reserved. The crew leave
Eldorna with information about her condition on paper and in her
HealthSpace. Eldorna knows that those involved in her care will
have access to parts of her electronic record and make notes.
(inspired by Surrey Ambulance Service and Chiltern and S. Bucks
PCT) Slide 10 National Programme for Information Technology,
London, 2004. All rights reserved. How Spine will work across
clusters in an emergency Transaction & Messaging Spine
Following an accident Tom visits A&E for assistance.... A&E
Doctor needs to view Toms Health Record... Search performed -
Record is found. PDS PSIS Data +ACF Legitimate relationship is
formed. Information is transmitted to A&E Doctor A London
resident Tom visits Blackpool.... Slide 11 National Programme for
Information Technology, London, 2004. All rights reserved.
Transaction & Messaging Spine A&E Doctor views Toms Health
Record... Carries out investigations & treats Tom... Toms
Information is Stored in the Local System Electronic Patient Record
sent via Spine to the PSIS PSIS Data How Spine will work across
clusters in an emergency Discharge Note generated sent to Spine
Alert generated sent to GP System via Spine Slide 12 National
Programme for Information Technology, London, 2004. All rights
reserved. How Spine will work across clusters in an emergency
Transaction & Messaging Spine Tom returns home to London.. GP
receives alert & discharge note Orders nursing careOrders
nursing care and medication Refers Tom to Physiotherapy (Choose and
Book) Refers Tom to Hospital Consultant (Choose and Book) eTP Slide
13 National Programme for Information Technology, London, 2004. All
rights reserved. Care Record Service in London 10 year programme
(year 3): 45 / approx 1500 GP Practices with new systems 1/ 30
hospitals (Queen Marys Sidcup) Choose and Book; 86% GP Practices
able to send & 32 Trusts able to receive (30/185k London /
national bookings so far) 7/22 PACs (2/8 Radiology in addition) For
2006/7: Single Assessment Process (Older People) 3 Boroughs / PCTs
Plan for 7 Hospitals, 5 Mental Health Trusts, 22 PCTs PACs to be
completed Pilot of Clinical spine Slide 14 National Programme for
Information Technology, London, 2004. All rights reserved.
Information Governance functions / tools that underpin the Care
Record Service Slide 15 National Programme for Information
Technology, London, 2004. All rights reserved. Patient
confidentiality No surprises: patients see and control what
information is shared Patient Guarantee Slide 16 Information
Governance functions / tools Function Status Recording patient
consent for information sharing Nominally live but key function
concerns Clinical spine that is not yet live Patient Access; Health
Space telephone and web live for Choose and Book, no dates for
later functionality Role-based Access Control (RBAC) defines the
functions available to staff Live some elements are application-
specific Smartcard authentication chip and PIN200k Smartcards in
England & 25k in London Legitimate relations for staff to
control whose records can be accessed Application &
Organisation specific at the moment Sealed envelopes; patients able
to have part of their information sealed away Not yet live Audit
trails Live; Application specific and varied at the moment Alerts
sent to Trust staffApplication specific and varied at the moment
Psedonymisation; information for reporting without patient id Will
be live shortly as part of Secondary Use Service Slide 17 National
Programme for Information Technology, London, 2004. All rights
reserved. Large-scale use of Smartcards and Role-based Access
Control Choose and Book issues with Smartcards: Effort of Smartcard
distribution and provision of support for use (e.g. loss /
forgetting cards and PINs) Locums Tension between local developing
business process and national roles (administrative staff being
given Clinical roles?) Queen Marys Sidcup Hospital (400 beds with
ED) = 1000+ users with Smartcards for the most part national roles
have worked with a proportion of staff with locally added functions
at minimal administrative effort Investigating proportion / effort
as part of a review in progress HR team run Smartcards
administration now Slide 18 National Programme for Information
Technology, London, 2004. All rights reserved. Active Information
Governance controversies London has a number of stakeholder groups
including: London Caldicott Guardians London Information Group
(non-clinical) London CFH LMC Group Controversies: openness / who
can view & who can edit demographic spine (choose and book
application) Legal basis for information sharing openness / who can
view & who can edit Smartcard spine Sharing of Smartcards
National Insurance number held on Smartcard spine Identity checks
for Smartcards issue (lack of co-ordination with other HR
requirements) Recording on paperwork required to issue Smartcards
(National Insurance & Passport number) Locums and temporary
staff Tension between local developing business process and
national roles (administrative staff being given Clinical roles?)
Slide 19 National Programme for Information Technology, London,
2004. All rights reserved. Summary Care Record Service is here!
Information Governance tools are being implemented incrementally
Consultation with the Public continues & Publicity campaign is
just starting in Trusts Stakeholder groups are gaining an
understanding and are storming! controversies are being addressed
Slide 20 National Programme for Information Technology, London,
2004. All rights reserved. Stephen Elgar NPfIT London Information
Governance Team Leader [email protected] 07736 706 538
