The Health Informatics Review - from words to deeds The Northern, Yorkshire and Humberside Directors of Informatics Fo

1. The Health Informatics Review - from words to deeds The Northern, Yorkshire and Humberside Directors of Informatics Forum 14 November 2008 Brian Derry brian.derry@ic.nhs.uk

2. Summary • Background to the Health Informatics Review • Health Informatics Review: • Strategy • Commitments • Next steps and conclusions

3. Background to HIR • Commissioned by NHS Chief Executive & DH Permanent Secretary in September 2007 • Over 1,400 stakeholders consulted: • 1,000+ frontline NHS staff • public opinion researched, through a deliberative event, online questionnaire and survey • voluntary organisations and professional bodies • SHA & NHS Chief Executive Officers and Chief Information Officers • Findings published as part of NHS Next Stage Review, 10 July 2008

4. HIR scope Health Informatics Review Programme Project 1 Meeting the information needs of theDH and NHS Project 2 Maximising the benefits from NHS CRS & SUS Project 3 Creating aninformation system and management structure “NHS CRS and SUS” “Governance” “Information” To outline an information and IT architecture capable of supporting the world-class NHS envisaged in the NHS Next Stage Review

5. NHS Next Stage Review

6. High quality care for all: NHS Next Stage Review • Raising standards • Stronger involvement of clinicians in decision making at every level of the NHS • Fostering a pioneering NHS • Help to stay healthy • Empowering patients • Most effective treatments for all • Keeping patients as safe as possible • Quality at the heart of the NHS • High quality care for all • Empowering frontline staff to lead change that improves quality for patients • Valuing the work of NHS staff • High quality care for patients and the public • Freedom to focus on quality

7. Need for high quality information • People want information to: • understand choices about care, & how to stay healthy • be confident that health & social care staff have the information needed to provide care effectively and safely • Care professionals:when providing care, regardless of where the person was previously seen • Commissioners:plan & redesign services • Managers of health & social care services: • monitor & assure quality • make decisions based on evidence & best practice • account for their actions • Regulators: to assure NHS & independent sector care providers

8. Strategic Implications

9. HIR key themes • Delivering better, safer care: person-based information for clinical & care processes, shared across organisational boundaries • Empowering staff to improve NHS performance: research, planning & management, improving quality of care & supporting regulatory activities • Empowering patients and the public: • making information available about health, services, & patients’ own health & wellbeing • providing patients with secure access to their own electronic records & increasing their involvement in shaping the NHS • Focusing on IT alone will not meet the needs of the NHS.

10. Patient information available at the point of need • Strategic solutions making patient/client information available securely across care settings • People will be able to: • access their own care record securely • have information to make informed choices about their own healthcare and wellbeing • Additional services available to patients on-line • Information should: • be collected once, as a by-product of care • be used many times - new data only when absolutely necessary • be improved through an integrated data quality programme. Strategic consequences

11. Clinical priorities • Achieving the strategic vision: • Investigate interim solutions & widening choice of LSP solutions • Local solutions subject to convergence with LSP & national strategic direction, & to local funding & business cases • Early delivery of priority secondary care products (“clinical five”): • PAS integrated with other systems & with sophisticated reporting • Order Communications and Diagnostics Reporting - all pathology & radiology tests, & tests ordered in primary care • Letters with coding: discharge summaries, clinic and A&E letters • Scheduling: beds, tests, theatres • e-Prescribing, including ‘To Take Out’ (TTO) medicines • Fill information gaps: • clinical metrics • mental health; community and social care.

12. HIR commitments Information and Standards Systems and Benefits Informatics-literate NHS

13. 1. Information & Standards

14. Information Actions • Filling gaps: • clinical metrics • Community • Mental health • Social care • Streamlining data collections • Data quality • Access and use: • Syndication & Signposting • Strategic reporting solution

15. DQ Guild Stakeholders Organisation reps Informatics professionals DQ Touchstone Comparator Quality Indicators Across datasets and collections. Linked to data catalogue. Frontline DQ Awareness and education. Impact of data quality on patients, organisations and staff. Basic DQ guidance DQ Accreditation Organisational DQ Standard framework. Self assessment tools. Formal audit. DQ monitoring. DQ Lexicon Signposts to existing tools and good practice. Special interest groups and forums. Data Quality Programme Stakeholders: Regulators: Healthcare Commission, Monitor, UK Statistics Authority, NAO, NICE Users: DH, Commissioners, SHAs, PCTs, researchers Data suppliers: SHAs, PCTs, NHS BSA, care providers Data quality mediators: Clinical Back Office, National Back Office, Local Back Offices, SHAs, PCTs System providers: CFH, LSPs, system suppliers

16. GP Extraction Service (GPES) • Extraction of GP data on a national basis for: • improved disease surveillance • clinical audit • commissioning patient services • improvements in managing public health • allocation of NHS resources • GPES will: • co-ordinate approved extractions • provide high quality analyses • protect patient interests - data only used for purpose for which approved • GPs may opt out of individual extracts • Openness, transparency and engagement with stakeholders

17. IC GP Extraction Tool (GPET) GPES components Contractor / supplier responsibility CfH Infrastructure made available eg RBAC, N3, PDS, Pseudonymisation etc Honest Broker IC data handling and analysis tools & technologies

18. Strategic Reporting – NHS Analysis and Reporting Service (NARS) • Part of the current SUS programme • Comparative analysis of service quality, efficiency and effectiveness • Replace Hospital Episodes Statistics Service when current contract ends • Supports NSR goal: Empowering frontline staff to lead change that improves quality for patients.

19. Information reporting programmes

20. Information Standards • Fundamental review of (1970s) NHS data model to create one suitable for 21st century NHS • Short- term improvements • meet immediate needs - community, mental health, private sector care & measures of clinical quality • reduce unnecessary bureaucracy • Scope of the NHS Care Records Service to cover independent & voluntary sector providers, & social care • Technology & standards to allow high quality local products to be integrated within hospitals; full integration of products across care settings & providers • Robust process to ensure widespread adoption of existing standards (e.g. NHS number, SNOMED)

21. Data Standards Programme -7 elements • Logical Health Record Architecture • logical structure for an Electronic Health Record • definitions for key clinical concepts & associated coding • Commissioning Data Sets Futures – community, children & maternity, long term conditions • Streamlining the end-to-end standards process • Social Care • Pathways Groups – maternity, long term conditions… • Metrics for measuring Care Outcomes • Analysis and Currencies – outputs & units of care activity

22. 2. Systems and Benefits

23. Systems supporting high quality care Delivering better, safer care Quality at the heart of the NHS NHS Care Records Service – Summary & detailed records Choose and Book PACS Electronic Prescription Service N3 Spine NHSMail Empowering patients and the public High quality care for patients and the public Empowering staff to improve NHS performance Freedom to focus on quality Secondary Uses Service Clinical Dashboards NHS Comparators Staff Gateway Research Capability Programme GP Extraction Service NHS Choices HealthSpace

24. Clinical dashboards Clinical team, ‘day-to-day efficiency’ dashboard Monthly ‘quality of care benchmarking’ dashboard Individual, ‘comparative clinician’ dashboard Allows clinicians to monitor and benchmark process effectiveness & outcomes against best practice. Focus on qualitative outcomes, e.g. patient experience, quality of care. Weekly/monthly updates. Allows clinicians to monitor individual metrics, compared with peers. ’Portfolio’ contributes to continued accreditation with professional bodies. Weekly/monthly updates. Locally defined dashboards: improve patient flow & treatment patterns; multi-disciplinary. Rapid updates (up to every 15 mins) • Indicators align to national/internationalbest practice & be integrated with national clinical protocols (e.g. designed by Royal Colleges)

25. Staff Gateway • Support NHS staff in delivering first class quality of care through education & training, & access to knowledge & information • NHS staff now have to access many different internal information & IT systems to do their jobs • Staff Gateway to provide: • ‘one-stop-shop’ for the key information sources • Professional portfolio: • single access point to development and knowledge • a space for storing information essential to appraisal, revalidation & clinical excellence awards • online log of personal activity & outcomes

26. HealthSpace • Empower patients & public • Already lets patients record information on their own health; also: • record preferences • record self-administered drugs & health monitoring • let patients see their own Summary Care Record

27. NHS Choices • Much more information - not just hospital care but also primary & community care • To be the reliable source of information to help patients understand their illnesses & stay healthy • In time, will include: • other services such as those provided by social care will be included. • new local and national clinical metrics and dashboards

28. 3. Informatics-literate NHS

29. Informatics-literate NHS Informatics-literate NHS Strong informatics governance Sound leadership Skilled staff Good processes Within DH & NHS Outside DH & NHS Standards governance Policy integration Investment assessment Informatics staff Other staff

30. Sound leadership • New CIO for Health – Christine Connelly - Board level post reporting directly to the NHS CEO • CIO for Health formal responsibility for professional leadership to the major informatics organisations inside and outside the Department of Health • Expectation that SHA, trust and PCT boards include a “credible, capable CIO able to contribute fully to strategic leadership and Board decisions” • National informatics leadership to: • develop the profession • co-ordinate the existing expertise • build the informatics capability of the general and management workforce

31. Skilled staff • Health Service leadership to address skills needed to deliver large scale IT-enabled change & to develop the Informatics Profession • Informatics content - to agreed national standards - in core training & professional developmentfor NHS clinicians and managers • Local leadership, prioritisation & delivery, with central support & resources • Informatics career pathways • Apprenticeship, graduate training & talent management schemes.

32. Priorities • Visible professional leadership, centrally and by SHA CIOs • Promoting the role of CIOs on NHS Boards, following the model of CIO for Health • Accreditation of informatics services, including processes & people • Initial focus on IT, information management and Programme and Project Management (PPM) specialists • Encourage registration with the United Kingdom Council of Health Informatics Professions (UKCHIP) • Subsidiarity for professional development - stronger local focus for governance, prioritisation and delivery, supported by nationally • Access to additional skilled resources to support local implementations, e.g. central support teams, national call-off contract.

33. Good processes • Improved arrangements for early assessment of the central and local informatics implications of new policy – “Policy and Business Informatics Support” • Ensure that IM&T priority and funding is given to the most appropriate requirements • Mainstream IM&T planning - NHS Operating Framework, IM&T planning guidance • Develop accreditation of HI services – function of products, processes & people

34. Conclusions

35. Key messages - 1 • Information and IT are central to: • improving health and social care services • empowering service users and staff • Investment in IT allows a leap forwards in the scope, availability & use of information • Emphasis on information about the quality of care, for patients, the public and staff • Renewed focus on delivering systems now to meet clinical priorities

36. Key messages - 2 • New CIO for Health: • reporting to NHS CEO • on NHS Management Board • underlines importance of informatics & provides a model for the NHS • Recognition of the importance of informatics skills & new impetus to developing the informatics profession and workforce

37. Key messages - 3 • NHS Connecting for Health: • Centre of IT expertise for NHS, not just NPfIT • Embrace private & voluntary healthcare providers, & Social Care • Information Centre for health and social care: • Maximise the value of data collected • Encourage innovation in information & analysis markets • Source of data for DH, CQC and other official statistics.

38. HIR next steps • Specific action plans – business cases, procurement, implementation etc • Implementation by the autumn, aimed more at informatics specialists, with detailed update & plans • Continued stakeholder engagement • Embed as “business as usual”

39. Your questions?