1
Dr Mark FerrarDirector of Infrastructure, NHS
Challenges & Opportunities for Distributed ICT in the NHS in England
And in the next half hour...
• Scale
• Consistency
• Connectivity
• Collaboration
• Identity
Scale
In a typical week...
• 6 million people visit their GP• Over 800,000 outpatients are treated• Over 10,000 babies are delivered by the NHS • Over 50,000 emergency journeys in NHS ambulances• District nurses make over 600,000 home visits • Pharmacists dispense ~8.5 million items• NHS surgeons performing ~1,200 hip operations, 3,000
heart operations and 1,050 kidney operations• Labs & associated services process millions of tests• That’s over 3 million critical transactions per day!
And in ICT...
• 700,000 PCs and 850,000 computer users in the NHS (in England)
• NHSmail has over 400,000 users• Amongst the world’s largest private, fully-featured, secure, single-domain e-mail
services
• NHSmail Relay Service processes 4,000,000 messages/day and activity bursts of 100 messages a second.
• N3 network transacts almost 100 terabytes of data each month• Equivalent to the 32 volume set of Encyclopaedia Britannica every 40 seconds
• The processing power of the NHS “Spine” (& its test environments) are equal to one of the top 100 supercomputers ever built
• Over 300 terabytes of storage – like the contents of a book shelf 3000km long
And remember the people...
Modern, integrated IT systems and services, connecting:
• 122,345 doctors
• 404,161 nurses
• 152,651 other health professionals
• Balance of 800,000+ computer system users are in administration functions across the NHS
• Most are degree educated or professionally qualified
• Most are also highly mobile throughout their work day
• Perhaps the largest “mobile knowledge worker” enterprise in the world!
Key delivery systems• NHS Care Records Service - Over 500,000 registered users
• Choose and Book - Over 10,000,000 bookings made
• Electronic Transmission of Prescriptions (ETP)
- Over 70,000,000 prescription messages issued
• N3 Network for the NHS - Almost 27,000 connections
• NHSmail - Almost 400,000 registered users
• Picture Archiving and Communications Systems
- Over 25,000,000 patient studies
- Over 600,000,000 images
• GP IT -
Quality Management and Analysis System
- 100% GP site deployment
GP to GP record transfer - Over 100,000 record transfers
What are "Secondary Uses"?
A considerable amount of information is collected during the provision of care and supporting services
The primary purpose of this information is to support and improve individual patient care
However, this information is of value for many other purposes to support healthcare and providing appropriate steps are taken to meet confidentiality obligations, this information can legitimately be used to support these other purposes.
These are called “secondary uses”
Identifiable Pseudonymised or Anonymised
•Individual records•Selected “lists” of
•records•Immediate access
•Dynamic, up to date•Workflow, rules based
•alerts
• Frequent abstracts•Focus on classes
of persons •Time series
•Short time intervals•Prospective indicators
•Focus on classesof persons
•Actual compared withexpected
(inputs, outcomes)• Ongoing
• Indicators
•Focus on classes or •cohorts
of persons• Disease, Service and
populationbased
• Forecasting•Periodic
OperationalDirect Care
Commissioning Analysis / Service Planning
BusinessOperations
Strategic /Policy / Research
Examples of characteristics of requirements
Primary and Secondary Uses
Objectives of SUS
To improve access to data to support the business requirements of the NHS and its stakeholders
To provide a range of software tools and functionality which enable users to analyse report and present this data
To be the single, authoritative and comprehensive source of high quality data
To enable linkage of data across all care settings
To ensure the consistent derivation of data items and construction of indicators for analysis
To improve the timeliness of data for analysis purposes
To provide a secure environment which enables patient confidentiality to be maintained according to national standards
SUS Information Flows
Presentation
Publication
Added-valueservice
providers
LocalSystems
NationalSpine
Manual Collection /Submission
ALB Use
LocalUse
DH Use
Local Data
DataManagement
DerivationsCalculations
DataCollection
Standards
Data Collection
Source systems
Data Management
Presentation Users
Some SUS statistics
16+ Terabytes of data in SUS
> £30 billion of PbR transactions processed
700+ million Activity records submitted to SUS
Over 1 million records entering SUS each day
Over 90,000 managed service extract reports produced from SUS
Over 12,000 user-defined extracts produced
Over 1500 users registered
Currently over 320 organisations submitting data
Consistency
We Can Only Influence Change
Remember how the NHS has historically dealt with data...
Raising the bar...
• “Patchy” NHS IT infrastructure maturity and performance
• “Infrastructure Themes” seen in 2005 still exist and some evidence best/worst gap widening
• TCO not lowest (or even competitive), despite being the 800lb Gorilla in IT purchasing in EU
• A consistent, well-managed desktop is vital for the success of Local & National IT programmes
• Premature use of high value technology prohibits lowest TCO and/or maximum benefit being realised soonest
Infrastructure Challenges...
• Significant cost - according to analysts, 70% of typical IT spend goes on IT Infrastructure! (run the organisation) – (70% of £2.2bn = £1.54bn)
• NHS IM&T Managers should not just rely on gut feel when setting investment priorities
• Inconsistent terminology makes it difficult to benchmark (TCO)• Organisational changes in the NHS means that many IT
infrastructures are in silos and not optimally managed• Some suppliers don’t create infrastructure solutions that NHS Trusts
request, actually need or are ready for• Many NHS Trusts need help to build coordinated infrastructure
improvement plans• Some key tasks often get overlooked because their impact on
infrastructure is not obvious
Enabing Consistency...
Enable consistency across the NHS in England by:
• Providing software through Enterprise Agreements
• Latest products at lowest cost
• Close relationships with suppliers
• Establish “yard stick” against which organisations can measure themselves (and compare with others)
• NHS Infrastructure Maturity Model (NIMM)
• Common User Interface programme (CUI)
• Collaboration Architecture & Solution Enablers (CASE)
• Harvest & Share good (best) practice
NIMM Summary
How should you use the NIMM?
• Perform a self assessment using the NIMM
• Prioritise and invest to improve lowest scoring areas
• Aim for a balanced score, rather than excellence in isolation
• Higher value MS EA technologies only available to those with CAPABILITY to exploit them
• Leverage capabilities of Core EA products that are licensed for all and don’t default to Enterprise products that aren’t – especially if your organisation isn’t ready to exploit them
Collaboration
Common Themes – Integrated Projects
Manage Risk
Responsiveness
Innovation
Competency
Efficiency
ROI/Business Value
Standards
Re-use
Agility
Consistency
What is NHS CASE?
Collaboration Architecture Solution Enablers
An end to end model to support the development of
collaboration solutions
A set of tools which can be used at various stages in developing collaboration
solutions
A set of candidate solutions described in business terms
to help the NHS envision their collaboration
capabilities
A mechanism to share via the PSPG good practices
and collaboration solutions
What was the driver for NHS CASE?
Technologies Architectures& Methodologies
CUIGood Practice
SSADM
Prince 2
What was the driver for NHS CASE?
Technologies Architectures& Methodologies
CUIGood Practice
SSADM
Prince 2
Business DriveTo Collaborate & Share
An end to end model to support the development of
collaboration solutions
A set of tools which can be used at various stages in developing collaboration
solutions
A set of candidate solutions described in business terms
to help the NHS envision their collaboration
capabilities
A mechanism to share via the PSPG good practices
and collaboration solutions
What’s in NHS CASE?
An end to end model to support the development of
collaboration solutions
BusinessImperatives
CollaborationCapabilities
Solution Design
Technology Architectures
Service Delivery
Governance
People & Change + Programme Management
What’s in NHS CASE?
A set of tools which can be used at various stages in developing collaboration
solutions
Collaboration DNA Ruler
OtherBusiness TasksPeople, Personal & SocialBusiness KnowledgeKnowledgeLists & InformationDocumentsAccess
Intr
anet
Inte
rnet
Fac
ing
Ext
rane
t – In
side
N3
Ext
rane
t – O
utsi
de N
3
Mob
ile A
cces
s
Offl
ine
Acc
ess
Doc
umen
t Man
agem
ent
Cen
tral
Lib
rary
& R
epos
itory
Doc
umen
t Arc
hivi
ng
Doc
umen
t Con
trol
s
Doc
umen
t Rig
hts
Man
agem
ent
List
Man
agem
ent
Rec
ords
Man
agem
ent
Cen
tral
Rec
ord
Rep
osito
ry
Sha
red
Tas
ks
Sha
red
Cal
enda
rs
Kno
wle
dge
Rep
osito
ry
Kno
wle
dge
Dis
cove
ry
Ent
erpr
ise
Sea
rch
Bus
ines
s In
telli
genc
e
Bus
ines
s R
epor
ting
Bal
ance
d S
core
card
s
Man
agem
ent D
ashb
oard
s
Key
Per
form
ance
Indi
cato
rs
Per
sona
l Inf
orm
atio
n
Tea
m F
ocus
Org
anis
atio
nal F
ocus
Tar
gete
d F
ocus
Soc
ial N
etw
orki
ng, B
logs
& W
ikis
Com
mun
icat
ion
& P
rese
nce
Con
fere
ncin
g &
Mee
tings
Bus
ines
s F
orm
s
Wor
kflo
w
Pro
ject
Info
rmat
ion
& R
epos
itory
Bus
ines
s N
ews
Arc
hive
Pol
icy
Con
trol
Drivers
Needs, Problems & Concerns
Capabilities Required Potential Benefit Areas
Functional Shared Workspaces
Staff expected to know what's going
on in their areaProfessional Profile
Staff recruitmentis difficult
Professional ProfileGive value for
moneyCost Customer is King
Team Focused Mass Publishing Targeted Publishing
Document Management List Management Document Controls
Social Networking Blogs Shared Calendars / Tasks
Mobility Archive Capability News
People have too much to read; how do they know what 's
important?
Link to : D5
NPC 9
A wide geographic area and culture [make it difficult for people to stay connected]
Link to : D5, D6, D8
NPC 10
Using Contractors is difficult because standard working
[practices] is not easily available
Link to : D3, D6, D9
NPC 13A
No Shared structures on file servers, etc.
Link to : D6
NPC 17
People don't know where to go to get information on a project
Link to : D2, D5, D6, D9
NPC 21A
Need to summarise what we're doing to avoid information
overload and drive consistency
Link to : D6
NPC 20
Need to make information easy to find
Link to : D6
NPC 23B
Policies and Procedures need to be easy to find
Link to : D5, D6, D7, D9
NPC 23A
Personal Development Cost Avoiding Efficiency & Productivity
Effectiveness Staff Morale Customer Satisfaction
Environment / Carbon Footprint
Value to the organisation?
Our
Abi
lity
to D
eliv
er?
1
High
High
Low
Low
2
3
4
5
6
7
8
91011
12
13
14
15
16
17
18
19
20
21
2223
Varying levels of understanding and interest of IT by our
customers
Link to : D2, D3, D4
NPC 2
Information overload
Link to : D6
NPC 3
Can't get access to information on the move
Link to : D6, D7, D10
NPC 6
Need to publish information and metrics internally, externally and
securely
Link to : D2, D4, D6
NPC 7
Need Information to be available through both Push and Pull
Link to : D6
NPC 8
Need to track and ensure staff have attended key briefs and
training
Link to : D6
NPC 1
We don't know what [information] we've got
Link to : D6
NPC 11
Need to avoid duplication [Linked to NPC11]
Link to : D3, D6, D9 & NPC 11
NPC 12
Using Contractors is difficult because standard working
[practices] is not easily available
Link to : D3, D6, D9
NPC 13A
Initiative
1
2
3
4
5
6
Extern
al –
Insid
e NHS
Extern
al –
Outsid
e NHS
Team
Foc
used
Mas
s Pub
lishin
g
Targe
ted
Publis
hing
Patien
t Ide
ntify
ing In
form
ation
Docum
ent M
anag
emen
t
List M
anag
emen
t
Docum
ent C
ontro
ls
What’s in NHS CASE?
A set of candidate solutions described in business terms
to help the NHS envision their collaboration
capabilities
Single Points of Information
Team Workspaces
Central Document Repository
Information Centre Manager’s Workbench
My Workspace Projects & Programmes
Secure HR Library Corporate Calendar
What’s in NHS CASE?
A mechanism to share via the PSPG good practices
and collaboration solutions
Internal Audit(Computer Audit)
Draft Annual Audit Plan & Timetable
SMT
Host PCT Risk & Audit Committee
Feedback / Rejection / Approval
AuditLibrary
Annual Audit Plan &
Timetable
Approved Annual Audit Plan & Timetable
Draft Approved
HIS Staff
Read Access to all final docs.
Step 2
Draft Audit Plan Mandate
HISDirector
Corp. ServicesManager
AreaLeadMgrs.
Draft Audit Plan Mandate
Final Audit Plan Mandate
Step 1
Operational Managers & Key Personnel
Step 3Final Audit Plan Mandate
Audit Tracking
Tool
Actions & Alerts
Access and updates
Host PCT Risk & Audit Committee
SMT
Access and updates
Evidence
Evidence
Draft Audit Report
Ste
p 4
Feedback
Draft Audit Report
Final Audit Report
Final Audit Report
Feedback
FeedbackLoop
Any Manager
Read Access to all draft & final docs.
Step 5
AuditActions
Ste
p 6
Draft Audit Report
Audit Collaboration
BCP & Emergency
Planning
Major Incident Plans
IT Recovery Plans
Public Paper Copy
Restricted Paper Copy (includes home phone numbers)
Sussex Emergency
Services
Updated Document
BC / MI Manager
Sussex HIS BCP Plan
BC / MI Manager
Contributors
HIS Staff
General Read Access
Business Unit Functional
Incident Plans
Action Cards
FEB
25
Annual Audit Plans
Internal Audit
Site Managers
FEB
25
Host PCT
Approval
Host PCT Board
Rehearsal Plans
Site Managers
Incident / Recovery Plans
Authorised Access
Review Team
Member
Plan Contributor
Business Continuity Planning
?
Performance Management
Enabling EWA...
• Microsoft
• NHS is Microsoft’s largest civilian customer and treated as a “segment of one” – i.e. Uniquely
• Most of Microsoft’s collaboration technologies are licensed to the NHS under this deal
• Novell
• NHS is Novell’s largest global customer
• Novell Identity Management and some collaboration technologies are licensed under this deal
• Oracle
• NHS is a “top 3” global customer for Oracle
• Most of the NHS’s centrally held data (e.g. SUS, PSIS) is stored in Oracle databases
Innovative solutions...
• Groove is a peer-to-peer collaboration environment which is part of Office 2007 Enterprise
• 100,000 Groove “seats” currently available for NHS use
• Many fewer than that deployed and in use – why?
• Groove needs thinking about!
• Groove is part of the offering of the Collaboration Environments & Solution Enablers (CASE) work done by Microsoft Enterprise Strategy Consultant working for CFH
• Groove is a great product... But...
• There are too few Groove solution partners in the UK
• NHS is experimenting with Groove, learning from it, learning a new way of working
• CFH looking to implement central Groove Relay for the NHS (directory)
Key platform updates...
• Moving NHSmail service to Microsoft Exchange 2007
• Largest Exchange 2007 implementation of its type in the world
• Moves 300,000 active accounts to new service whilst maintaining service continuity.
• Engaged end users throughout the design process, ensuring those who’ll use NHSmail have a service that meets their needs
• Over 500 servers installed two new secure Data Centres built by C&W
• New servers currently undergoing final build & commissioning
• Each mail server has 20TB storage and is part of a 3 node geographically diverse cluster (each has dedicated storage)
• Over 1300 separate Design Requirements documented in over 2,000 pages
Connectivity
Architecture Overview
Messaging/Integration Backbone (TMS)
LSP Data Centre
Local ApplicationInstance
EPR
Local Application Integration
Local ApplicationInstance
EPR
Local DataWarehouse
MI
Terminology/Decision Support
Terms &Drug dB
LSP User Domain
Primary User Secondary User Tertiary User Community User
ICRS NASP Data Warehouse
SUS
SUS
SUS
CAB NASP Domain
CAB Data Store
E-Booking Application
Booking Management
Service
Telephone
ebX
ML
/ HL
7 V3
HL
7 V3
ICRS NASP Domain
SSB
PDSPSIS
SDS
ACF
Secondary Care Application
EPS
(Security & Access )
Enhanced Retained Legacy Systems
Primary User Secondary User
SecurityInfrastructure
Primary CareApplication
EPR
Secondary CareApplication
EPR
Event Engine/Integration Layer
Event Engine/Integration Layer
Integration Overview
LSP Data Centre
Local ApplicationInstance
EPR
Local Application Integration
Local ApplicationInstance
EPR
Local DataWarehouse
MI
Terminology/Decision Support
Terms &Drug dB
LSP User Domain
Primary User Secondary User Tertiary User Community User
LSP Data Centre
Local ApplicationInstance
EPR
Local Application Integration
Local ApplicationInstance
EPR
Local DataWarehouse
MI
Terminology/Decision Support
Terms &Drug dB
LSP User Domain
Primary User Secondary User Tertiary User Community User
BT MPLS(N3 IP VPN)
N3 PoPs
N3 Users
Private Circuit
DSLEthernet Access
Private Circuit
DSL
Ethernet Access
N3 Users
3rd Party Service Provider Local/National Service Provider
Data Centre(Primary)
Data Centre(Primary)
Data Centre(Secondary)
Other NHS organisations
Internet
NHS Direct
COINs
Data Centre(Secondary)
N3 Architecture Schema
N3 Physical TopologyDevice Naming
Colindale = n3-ld-c-01-colind-xxFaraday = n3-ld-c-03-farady-xxKingston IG = n3-ld-c-inetgw-xx
Where xx = router number
AS 64530(Kingston IG)
AS 64669(IPStream)
AS 64551 (Colindale PoP)
AS 65500(BTW)
R60 R67 6
BTW-NTE1
BTW-FER1
BTW-NTE2
BTW-FER2
R01
R51 R52
BTW-NTE1
BTW-FER1
BTW-NTE2
BTW-FER2
1110
AS 64552 (Faraday PoP)
R01
TSrv-96
R02
TSrv-96
R02IG-R01
400, 402
400, 402, 415
8R70 8
R55 0
R51 10 R52 11
. . . . .
.97 8R70 8
G1/1
G5/1-2
G5/1-2
G1/2
415 425
425415
G1/1
G1/2G1/2
G1/1
G1/1
G2/2G2/2G2/2G2/2 G1/7 G1/7
G1/2
R67 6R55 0 R60 5. . . . .
G5/1-2
G5/1-2
G2/1 G2/1G2/1G2/1
G0/0G0/1
G2/3G2/4 G2/3G2/4
G0/0G0/1
G0/0G0/1
410
411
410, 412
R71 9R71 9
G2/1 G2/1 G2/1 G2/1
G1/0/2 G1/0/2G1/0/2G1/0/2
420, 422 420
421423
421
G0/0
G0/1
G2/3 G2/4G2/4G2/3
G0/1G0/0 G0/1G0/0
5
400, 402, 425
Te3/3 Te3/3
Te3/4Te3/4
G1/0/12 G1/0/12
421423
411413
411413
G1/0/1 G1/0/1 G1/0/1 G1/0/1
G1/3 G1/4 G1/3 G1/4G3/1
G3/6
G3/7 G3/1
G3/6
G3/7
AS 2856 (MPLS Core)
IG-R02
VLAN ID VLAN Description400 DSL Internet Transit LAN
402 OSP F Transit LAN410, 411 Session Handoff LANs412, 413 DSL Transport LANs415 DSL Core Transit LAN420, 421 Session Handoff LANs422, 423 DSL Transport LANs425 DSL Core Transit LAN
Faraday
GigE Ring
Colindale
Terminal Sever Ports attached to Async 0/1/xx
Colindale Faraday xx xx
400, 402
400, 402
400, 402
F2/6
F0/0F0/0
F2/6
Colindale Faraday
Hospital 1
Hospital 2
NHSnet
NHSnet Router
Hospital
Hospital
Hospital
• N3 is not just one Wide Area Network, but many...
• Communnity of Interest Networks (CoINs) connect local infrastructures across some Health Communities
• CoINs connected by N3 to rest of N3 and other networks
CoINs
Identity
Who is an "NHS user"?
• Spine Directory uses Sun One• NHSmail uses Active Directory• 65% of 12,000 NOS use Microsoft AD (or NT4!)• 35% of 12,000 NOS use Novell eDirectory (or NDS!)• ESR is Oracle database for most (but not all) NHS workers
• An unknown number of application services holding their own username & password lists
• ID badges and building access “swipecards”• Telephone exchanges & mobile phones• And web sites and external applications (e.g. Academic systems)
• All with different administration and standards
Reduce identity chaos...
• Reduce user and administrator effort by integrating multiple identities belonging to the same person
• Synchronise some identity information
• Federate some directory services
• Deliver “self-administration” portals for users
• Establish provision/de-provision links and processes
• Leverage identity proof at the highest level (e-GIF L3)
• Make the NHS smart card the “key” to all other identities (if you can’t eliminate them)
Summary
• Scale• The scale of the NHS provides challenges to data consistency, connectivity,
effective collaboration all whilst being sure of a person’s identity (because of confidentiality)
• Consistency• Providing enablers and examples of good practice help drive towards consistent
infrastructure, systems and data
• Connectivity• The connectivity challenge of the NHS is significant – but it is not just about the
“wiring” – though that is a challenge in itself
• Collaboration• Knowledge workers collaborate – but we need consistent ways to enable that over
greater distances and with more people
• Identity• The NHS identity management challenge is considerable – organic growth of
services must be enabled by effective use of our most “sure” identity services