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Dr Jonathan KayClinical Informatics Advisor
NHS England
The need for networksMarch 2014
Prof Jonathan KayClinical Informatics DirectorNHS England
Computerisation
• Can improve patient safety• Reduce discontinuities
• Within organisations• Between organisations• But… Passive approach to safety management
• Can reduce unit cost of processes• Remove tasks from humans• Reduce waste• But… Ignorance of unit costs of processes
The NHS in England
• 7,600 GP practices (partnerships, self-employed)• 161 acute trusts • 56 mental health trusts• 36 community providers (including 18 social enterprises)• 10 ambulance trusts
• Net expenditure has increased from £57 billion in 2002/03 to £105 bn ($159 billion) in 2012/13.
• Expenditure per capita per annum has increased from £1,287 in 2003/04 to £1,979 ($3,008) in 2010/11.
NHS England
• Commissioning body for healthcare• Created on 1 April 2013
• Receives funds from the Department of Health• Receives an annual mandate with priority areas
Commissioning care
• Primary care commissioned by NHS England through the national GP contract
• Secondary care commissioned through 211 clinical commissioning groups, run by GPs, funded by NHS England
• Specialised care commissioned by NHS England
• Social care funded and delivered separately
Clinical information systems: GPs
• Fully computerised, many for over 20y• Dedicated vertical market suppliers• Computerised delivery of laboratory reports• Computerised patient registration to national system
• Large amounts of time spent importing and exporting information
• Used by GPs but not all primary care staff
CIS: Hospital care
• Fully computerised functions:• Patient registration• Laboratories (and most requests and reports)• Radiology (100% local PACS)
• Departmental systems…
• Architecture• “Best of breed” vs “Single EPR”• Communication to national system
Weaknesses of current CIS
• Often based on single organisations rather than needs of clinicians or patients
• Inflexible
• Problems with interoperability
• Problems with standards
• Poor or nonexistent evaluation
• Little or no knowledge management
National systems
• Demographics• Private network and email system• Summary Care Record• Choose and Book
• Aggregated activity systems
Clinical Digital Maturity Index
• Collaboration with eHealth Insider• Now launched, free access for the NHS• How should it develop?
What do clinicians tell me?
• Feels backwards compared to… education, social communications, ecommerce… “Why can’t we… ?”
• Not joined up• Systems don’t quite meet their needs• Others do it better• What did the GPs get right?
What does NHS England tell me?
• Make it safer• Spend less• Provide care closer to home
• Avoid unplanned admissions• Avoid planned admissions• Self-care• Third sector care• Remember social care
• Better care for patients with long-term conditions• Improve accountability and transparency
What do implementers tell me?(according to some other people)
• Luddite clinicians
• Information governance/ data protection etc
• Information systems: Legacy, new, cost, cost of change
• Split of primary and secondary care
• Data standards
• Burden of data collection
• Capacity of ICT staff
• Capacity in project management
• Capacity in clinical informatics
• Legacy of National Programme for IT
Barriers to improvement
• Organisational structures and assumptions
• The difficulty of identifying cash-releasing savings
• The last 5 metres to the bedside
• Dogmas that aren’t challenged
Opportunities from people
• Chief Clinical Information Officers, but more of them and more effective, and from all HCPs, and from commissioners
• Chief Information Officers
• Young practitioners• Practitioners who have worked elsewhere
• Professionalisation
• Enabled patients
Opportunities from technology
• Networked fixed computers
• Networked handheld computers
• Cloud services
• Autoidentification
• Everyday technology
• Better clinical information systems
NHS England: Big projects
• Technology Fund
• Nursing Technology Fund
• Digital Primary Care
• care.data
• NHS Choices
• Others
• What’s missing?
Technology Fund
• First round allocated• Very tight timing• Matched capital• Themes
• Computerised medicine management• Interoperability• Others
• Computerised document management• Portals
• Accelerator sites
Medicines management
• Computerisation of prescribing• Computerisation of administration
• The last 5 metres
• Inpatients: Transfer from and to primary care• Outpatients: Joint management
Unplanned care
• Navigating the system• Access to existing records• Adding the record of the unplanned encounter
• Working differently
Long-term conditions
• CIS that span all the organisations and settings of care• Smart systems that identify deterioration earlier• Managing investigations used for monitoring differently from those
used for diagnosis
• New suppliers
• Working differently
Reorganisation of specialist services
• Likely changes• Need for interoperability of CIS• Who is responsible in the new NHS structures?
Interoperability
• Integration/ Communication/ Interoperability
• What are the barriers?• Network technology and availability• Data standards• Organisational barriers
• Who is going to solve this?• Local• National• Suppliers
Handover
• Task-oriented views or systems• Persistence of tasks across time, distance, systems and organisations• Escalation on noncompletion
The last 5 metres (yards) to the bedside• Prescription• Administration of medicines• Requesting laboratory investigations• Blood transfusion• Data from monitoring devices• Point of care testing
• Handheld devices• Wireless networks (Survey etc)• Patient identification for procedures
