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Integrated Care Records Service in London 23 October 2003 David Kwo Chief Information Officer London ICT Programme

Integrated Care Records Service in London 23 … · Integrated Care Records Service in London 23 October 2003 ... Mental Health Act Administration ... Nursing Hospital Psychiatry

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Integrated Care Records Service in London

23 October 2003

David KwoChief Information Officer London ICT Programme

Contents

• What is ICRS?• How London fits into the picture• Key Issues

What is ICRS?

Integrated Care Record Service (ICRS)

• ICRS will provide consistent clinical support and secure patient data across all care settings: – Nationally, a repository of summary

patient information (NHS Spine)– Locally, tools for aiding delivery of

patient-centred care– Both facilitating the secure sharing of

electronic patient records

Integrated Care Record Service – scope and roles

Sample Set of Generic Processes

Range of Care Settings

Flexible Toolkit to Support Range of Data and Viewing Requirements

INTE

GR

ATE

D C

AR

E R

EC

OR

D S

ER

VIC

E

Master Patient Index (eMPI)Order Entry

Results Reporting

E-prescribingE-booking

Integrated Care Pathways

Resource scheduling

Screening

Bed Management

Ambulatory Care Management

Mental Health Act Administration

Clinical Decision Support

Confidentiality

Authentication Domiciliary Care Management

Clinical Noting

Clinical Correspondence/Summary

Management InformationGraphical AnalysisImage Management Casenote and Film Tracking

NHS Spine

Personal DemographicServices

E-booking

Electronic Transferof prescriptions

Common Services

Nationally built by NASPsand locally

implemented by LSPs Locally configured and locally implemented by LSPs

Cardiology Anaesthesiology

Intensive Care

Diabetes Theatres

Radiology

Pathology

MaternityOld Age Psychiatry

Radiotherapy

Child Health Screening

Trauma Rehabilitation

Respite Care

Palliative CareColposcopy

Nephrology

Endoscopy

DTCsACADs

GeneralPractice

AcuteHospital

CommunityNursing

HospitalPsychiatry

Therapies(OT/PT)

CommunityMental Health

DiagnosticDepartmentsHome

TertiaryCare

NHSDirect

PrisonSocialCare Hospices Private

HealthAmbulanceWalk-InCentres

National ICRSLocal ICRS

Integrated Care Record Service – scope and roles

Sample Set of Generic Processes

Range of Care Settings

Flexible Toolkit to Support Range of Data and Viewing Requirements

INTE

GR

ATE

D C

AR

E R

EC

OR

D S

ER

VIC

E

Master Patient Index (eMPI)Order Entry

Results Reporting

E-prescribingE-booking

Integrated Care Pathways

Resource scheduling

Screening

Bed Management

Ambulatory Care Management

Mental Health Act Administration

Clinical Decision Support

Confidentiality

Authentication Domiciliary Care Management

Clinical Noting

Clinical Correspondence/Summary

Management InformationGraphical AnalysisImage Management Casenote and Film Tracking

NHS Spine

Personal DemographicServices

E-booking

Electronic Transferof prescriptions

Common Services

Nationally built by NASPsand locally

implemented by LSPs Locally configured and locally implemented by LSPs

Cardiology Anaesthesiology

Intensive Care

Diabetes Theatres

Radiology

Pathology

MaternityOld Age Psychiatry

Radiotherapy

Child Health Screening

Trauma Rehabilitation

Respite Care

Palliative CareColposcopy

Nephrology

Endoscopy

DTCsACADs

GeneralPractice

AcuteHospital

CommunityNursing

HospitalPsychiatry

Therapies(OT/PT)

CommunityMental Health

DiagnosticDepartmentsHome

TertiaryCare

NHSDirect

PrisonSocialCare Hospices Private

HealthAmbulanceWalk-InCentres

National ICRSLocal ICRS

Timescales

• ICRS phase 1 December 2004• ICRS phase 2 December 2006• E-Booking functional December

2005• Infrastructure full connectivity

March 2005

Transformation

To:Whole continuum systemsClinical Patient’s NHS NumberFew systems/single solution setConsistent version(s) cross clusterPrimary/community/home focusPatient access/common interfaceModern, reliable, planned refresh Deep clinical functionality for allAdherence to standardsRich management information driven from clinical practice with knowledge and clinical decision support common place

Of systems from:Silo or organisation systemsAdministrativeMany patient identifiers1000’s of systems/many suppliersMany versionsAcute focusNo patient access Ageing legacy environmentDeep clinical functionality for fewMany technologies, few standardsLittle mgt info for PCT/SHA, lack of knowledge in general

To:“We make the best use of ICRS to improve care”

Of attitude from:“We use the best systems in our organisation”

How London Fits into the Picture

London is one offive NPfIT Clusters.Each Cluster is responsible for localimplementation of ICRS.

(NPfIT’s geographic grouping of StrategicHealth Authorities in England)

London has...

• 32 acute trusts• 32 PCTs (1600 GP practices)• 10 mental health trusts• 31 Local Authorities

‘The London Museum of IT’

LSL Health Community

Trusts

Lewisham

Guys & St Thomas

PCTs

iSoft/SCMKing’s

iSoft/SCM SocialServices

Bexley & Greenwich Health Community

Trusts

Greenwich

Queen Elizabeth

McKessonStar

PCTs

Queen Mary’s Sidcup

SocialServices

Bromley Health Community

PCTs TrustsSocial

Services

Bromley

Siemens/Elan

South East London StHA

McKesson/Star

McKesson/Star

North Central London StHABarnet Health Community

PCTs TrustsSocial

Services

Royal Free Hampstead

Camden & Islington Health Community

Trusts

UCLH

Whittington

McKesson/Star

Barnet & Chase Farm

Cerner

(McKesson/Star)

McKesson/Star

PCTsSocial

Services

North Central London StHABarnet Health Community

PCTs TrustsSocial

Services

Royal Free Hampstead

Camden & Islington Health Community

Trusts

UCLH

Whittington

McKesson/Star

Barnet & Chase Farm

Cerner

(McKesson/Star)

McKesson/Star

PCTsSocial

Services

North West London StHA

KCW Health Community

Trusts

St Mary’s

Royal Brompton/Harefield

iSoft/NGate

PCTs

Chelsea & Westminster

IDX SocialServices

EHH Health Community

Trusts

Hammersmith

Ealing

IMS

PCTs

iSoft/ACTWest Middlesex

SocialServices

iSoft/ACT

Brent & Harrow Health Community

PCTs TrustsSocial

Services

North West London

iSoft/ACT/McKesson

Hillingdon Health Community

PCTs TrustsSocial

Services

Hillingdon

iSoft/Torex

iSoft/ACT

North East London StHABarking Health Community

PCTs TrustsSocial

Services

East London & City Health Community

Trusts

Bart’s/London

Homerton

Barking, Havering & R.

JEC System

PCTs

(McKesson/Trak)

(JEC System)

Newham

(JEC System)Social

Services

Waltham Forest

iSoft

MSW Health Community

Trusts

St Helier

St George’s

iSoft/SCM

PCTsIn-House Social

Services

Kingston Health Community

Trusts

Kingston

TorexPCTs Social

Services

Croydon Health Community

PCTs TrustsSocial

Services

Mayday

South West London StHA

McKesson/Star

London aims to...

… provide the world’s leading metropolitan healthcare system

… support London's care services in the modernisation of their culture, skills and processes, enabled by communications infrastructure and technology that ensure citizens and health and social services professionals have fast, safe, and equitable access to information and clinical services, whenever and wherever needed.

Assess,Plan,

Record,Inform

Test/Screen,Treat,

Schedule,Inform

Results,Quality,

Audit…

Clinical Process

Plan

Action

Review

Assess,Plan,

Record,Inform

Test/Screen,Treat,

Schedule,Inform

Results,Outcomes,

Audit…

Clinical Process

Plan

Action

Review

HistoricallyClinical Process and Systems Support

Assess,Plan,

Record,Inform

Test/Screen,Treat,

Schedule,Inform

ReviewResults,

OutcomesAudit

Plan

Action

Review

Hospital GP Community Mental Health Social Care

PAS PAS PAS

HistoricallyClinical Process and Systems Support

Assess,Plan,

Record,Inform

Test/Screen,Treat,

Schedule,Inform

ReviewResults,

OutcomesAudit

Plan

Action

Review

Hospital GP Community Mental Health Social Care

PAS PAS PAS

1. Fragmented and thin processes and

systems within organisation

Assess,Plan,

Record,Inform

Test/Screen,Treat,

Schedule,Inform

ReviewResults,

OutcomesAudit

Plan

Action

Review

Historically

Hospital GP Community Mental Health Social Care

Clinical Process and Systems Support

PAS PAS PAS

2. At least in acutes, we tend to focus on actions (tests, drugs, etc) rather than what we intended (care plan) and whether

it was worth it (quality/outcome)

HistoricallyClinical Process and Systems Support

Assess,Plan,

Record,Inform

Test/Screen,Treat,

Schedule,Inform

ReviewResults,

OutcomesAudit

Plan

Action

Review

Hospital GP Community Mental Health Social Care

PAS PAS PAS

3. Thus, we’re not in full control of

our business processes within

health organisations

Historically

Assess,Plan,

Record,Inform

Test/Screen,Treat,

Schedule,Inform

ReviewResults,

OutcomesAudit

Plan

Action

Review

Hospital GP Community Mental Health Social Care

Clinical Process and Systems Support

PAS PAS PAS

4. And, we have poor processes and control

ACROSS health organisations,

professionals and agencies: this bad for

patients and staff

But nowClinical Process and Systems Support

Assess,Plan,

Record,Inform

Test/Screen,Treat,

Schedule,Inform

ReviewResults,

OutcomesAudit

Plan

Action

Review

Hospital GP Community Mental Health Social Care

PAS PAS PAS

ICRS

AssessmentCare Planing

DocumentationOrdersResults

PrescribingTherapiesSchedulePathwaysProtocolsScreeningImaging

CDSSWorkflow

AuditSec’y Analysis

eHealthTelecareCharging[Clinicals]

But nowClinical Process and Systems Support

Assess,Plan,

Record,Inform

Test/Screen,Treat,

Schedule,Inform

ReviewResults,

OutcomesAudit

Plan

Action

Review

Hospital GP Community Mental Health Social Care

PAS PAS PAS

ICRS

AssessmentCare Planing

DocumentationOrdersResults

PrescribingTherapiesSchedulePathwaysProtocolsScreeningImaging

CDSSWorkflow

AuditSec’y Analysis

eHealthTelecareCharging[Clinicals]

Active Shared Functions: Assessments/SAP

Active Shared Functions: Community Wide Scheduling

Active Shared Functions: Community Wide Pathways

Active Shared Functions: Community Wide Workflow

Active Shared Functions: Community Wide IRT, eCPA

Active Shared Functions: etc.

But nowClinical Process and Systems Support

Assess,Plan,

Record,Inform

Test/Screen,Treat,

Schedule,Inform

ReviewResults,

OutcomesAudit

Plan

Action

Review

Hospital GP Community Mental Health Social Care

PAS PAS PAS

ICRS

AssessmentCare Planing

DocumentationOrdersResults

PrescribingTherapiesSchedulePathwaysProtocolsScreeningImaging

CDSSWorkflow

AuditSec’y Analysis

eHealthTelecareCharging[Clinicals]

Active Shared Functions: Assessments/SAP

Active Shared Functions: Community Wide Scheduling

Active Shared Functions: Community Wide Pathways

Active Shared Functions: Community Wide Workflow

Active Shared Functions: Community Wide IRT, eCPA

Active Shared Functions: etc.

But nowClinical Process and Systems Support

Assess,Plan,

Record,Inform

Test/Screen,Treat,

Schedule,Inform

ReviewResults,

OutcomesAudit

Plan

Action

Review

Hospital GP Community Mental Health Social Care

PAS PAS PAS

ICRS

AssessmentCare Planing

DocumentationOrdersResults

PrescribingTherapiesSchedulePathwaysProtocolsScreeningImaging

CDSSWorkflow

AuditSec’y Analysis

eHealthTelecareCharging[Clinicals]

Interface ICRS with Legacy?

But nowClinical Process and Systems Support

Assess,Plan,

Record,Inform

Test/Screen,Treat,

Schedule,Inform

ReviewResults,

OutcomesAudit

Plan

Action

Review

Hospital GP Community Mental Health Social Care

PAS PAS PAS

ICRS

AssessmentCare Planing

DocumentationOrdersResults

PrescribingTherapiesSchedulePathwaysProtocolsScreeningImaging

CDSSWorkflow

AuditSec’y Analysis

eHealthTelecareCharging[Clinicals]

Separate PMI, user interface, duplicate data; new interfaces,

commercial interests, etc.

Separate PMI, user interface, duplicate data; new interfaces,

commercial interests, etc.

But nowClinical Process and Systems Support

Assess,Plan,

Record,Inform

Test/Screen,Treat,

Schedule,Inform

ReviewResults,

OutcomesAudit

Plan

Action

Review

Hospital GP Community Mental Health Social Care

PAS PAS PAS

ICRS

AssessmentCare Planing

DocumentationOrdersResults

PrescribingTherapiesSchedulePathwaysProtocolsScreeningImaging

CDSSWorkflow

AuditSec’y Analysis

eHealthTelecareCharging[Clinicals]

ICRS Implementation Priorities

• Order communications• Prescribing• Decision support

• Bates & Gawande NEJM June 2003

Implementation Approach

Design

Build & Test

Deploy Standard Product

Best Practice

NSF’s, SAP, CPA

•NICE

•CHAI

•Guidelines

•NELH

•MA

Pan London•Clinical design teams

•Build team

•Best Practice Focus Groups

•Infrastructure

•LSP

TrustTrust

TrustTrust

TrustTrust

TrustTrust

TrustTrust

TrustTrust

TrustTrust

TrustTrust

Local communities•Deployment teams•Benefits realisation•Local B/Case

Clinician-Lead Development

• 360+ different clinical/audit systems• Migrate to ICRS over time• Clinicians to lead spec’n, testing,

prototyping• Local developers certified • Retains innovation and engagement• IPR potential issue• Clinical research potential

Issues

• Clinician attitudes• Communication• Funding• Clinical research• Technology• Data quality

Likely clinician response to inaccurate or out-of-date clinical content

CEOCEO

CMO in helicopterCMO in helicopter

Clinical StaffClinical Staff

Thank you

David Kwo

Email: [email protected]

Tel: 020 7725 5595