NHS NPfIT National Health Service National Programme for IT

1. NHS NPfIT National Health Service National Programme for IT

2. Care Records Service Vision “Working together we will deliver the world’s best healthcare system. We will establish a safe, secure and cost-effective integrated health records service, empowering NHS staff to deliver the highest quality of patient care. This will enable a step change in healthcare provision.”

3. Home On-line Information Self Management On-line Advice eBooking Spine Handles Messages Self care Digital TV/Web Provides access to personal health records Primary Care ? Primary care History Spine contains national level summary eTP Transfer of Prescriptions eTP Dispensing Community care Use in the community Secondary& Tertiary care Unscheduled Care Available for Emergencies Remote Orders Arrangement Of Transport Projected Benefits

4. posted/ e-booking posted posted posted posted Radiology Consultant Acute Care Patient Journey – Pre CRS Told date/ visit Arrange/ visit Arrange/ visit Told date/ visit Arrange/ visit Told date/ visit Patient Further diagnosis Further tests Initiate treatment GP Referral Database / Manual records

5. Arrange/ visit Visits at agreed time Arrange/ visit Visits at agreed time Arrange/ visit Visits at agreed time Results on-line, book admission on-line Results on-line, book further appointment on-line Further tests reqd. book appointment on-line Radiology Consultant Acute Care Integrated Care Record System Patient Journey – Post CRS Patient GP Referral Database / Manual records

6. Integrated • PAS • Clinical • Decision support Out of hours Nursing homes Outpatient facilities • One solution across all care settings Focus on the care continuum • Beds or no beds, consistent patient care Clinics Hospitals GP surgeries Patient bedside Doctors‘ homes Interoperability

7. Patient Management Patient Care Staff Improved consistency of performance Improved access to patient data in other organisations Reduced medical errors Procedures Ability to meet directives for workforce staffing levels and flexibility Integration of care across multi-organisation pathways Improved patient health assessment Improved appointment management Improved statistical and reporting information Improved staff retention / recruitment Improved information on performance Reduced mortality and morbidity Improved care provider collaboration Increased job satisfaction and morale Decreased waiting time (prior to and at point of care) Improved patient involvement An integrated solution Cost Reduction Reduced cost of supplies, drugs, etc., including substitution with lower cost options Improved access to research information A seamless system user interface Reduced capital and operational costs of IT Improved patient care planning Improved application of care guidelines Reduced risk of litigation Reduced procedural errors Revenue Increase Reduced staff time Faster results turnaround Sale of medical and statistical data for research Increased patient throughput Improved charge capture Benefits of the LSP Programmes

8. Technology BENEFITS Cultural change Process .... and have complex inter-relationships. Benefits come from various sources ....

9. NHS NPfIT Clusters From www.e-health-insider.com

10. The London Cluster NC NE NW • 5 Strategic Health Authorities • 7.2m People • 32 Acute Trusts • 10 Mental Health Trusts • 1,660 GP Practices in 31 PCT’s • Total Potential Users 195,000 • 4,600 GPs • 15,000 Practice Staff • 5,400 Consultants • 10,400 Other medical staff • 130,000 Non-medical • 30,000 Social Services SE SW

11. Largest ICT services provider to the NHS • 103,000 employees • A long and continuous heritage of successful delivery to the NHS • 300 employees dedicated to the NHS • Leading provider of healthcare information technology, spanning the full care continuum • 2100 employees • Five years in London: Chelsea and Westminster Trust & recently UCLH • Specialists in the implementation of clinical and administrative applications for the hospital sector • 4500 people focused on hospital application implementation and support • Experience in over 300 large acute facilities • Business and technology consultancy/application integration experts for the public sector • Built and manage the Government UK Online portal - 3 million page views a month The Capital Care Alliance

12. 7 Strategic Health Authorities • 48 Acute Trusts • 18 Mental Health Trusts • 1,938 GP Practices in 81 PCT's • 12 Ambulance Trusts • 13 Million patients • 256,000 Staff The Southern Cluster Thames Valley Avon Glos Wilts Kent & Midway Hants &IOW Dorset & Somerset Surrey & Sussex SW Peninsula

13. Prime contractor • Programme & contract management • Implementation management • Public sector contracting • IT service management • Operation of the solution • Business change management • Leading provider of healthcare information technology, spanning the full care continuum • 2100 employees • Five years in London: Chelsea and Westminster Trust & recently UCLH • System integration and implementation • Skills required for implementation of clinical applications • Legacy systems integration The Fujitsu Alliance

14. Security and training • Training • Security and design of data management solutions • Some of the NHS domain expertise • Contracted by the Fujitsu Alliance to undertake the BPPDG work for the Southern Cluster The Fujitsu Alliance

15. Electronic Booking Service (EBS) Atos Origin StHA StHA StHA StHA StHA Mini-Spine The National NHS Care Record Service (BT) Health Record Electronic Prescribing (ETP) N3 Mini-Spine Mini-Spine Mini-Spine Local Service Providers and NPfIT LSP South West, South East Fujitsu Alliance Local Service Provider London BT LSP North West & West Midlands CSC LSP North East, Yorkshire & Humberside Accenture LSP East Midlands, East of England Accenture

16. Common Functions Common User Interface Full CDR Event Publisher Spine London LSP Architecture CCA Gateway Portal CCA Gateway Portal IDX ICRS Niche Systems

17. 2004 2005 2006 2007 2008 2009 2010 Phase Two Phase One Phase Three Model Community Build Service Offer Development P1R1 P1R2 P2R1 Dev P2R2 Develop P3R1 Service Implementation & Delivery Planning P1R1 P1R2 Deploy P2R1 Deploy P2R2 Deploy P3R1 Key Milestones

18. What can New Zealand learn? • Integrated regional system • National “spine” and transferable records • Strong authentication of users • Choose-and-Book (eBooking) • Best Practice Process Design • “Sealed envelopes” • ePrescribing

19. Process Best Practice Process Design What must the What must the What must we do What must we do system do for us system do for us differently to gain differently to gain Best Practice Best Practice Best Practice Best Practice to be able to do to be able to do Process Design Process Design the most benefits the most benefits Process Design Process Design our job? our job? from the system? from the system? Informing the Informing the Informing the Informing the design design design design of the system of the system of how we work of how we work Standardised customisation Standardised customisation Local Process Redesign / Local Process Redesign / of the system build for London of the system build Change Management Change Management • • clinical need clinical need • • local flexibility? local flexibility? • • national mandate national mandate • • case for change case for change • • system constraints system constraints • • ownership ownership

20. NHS responsibility Joint responsibility Existing Process Best Practice Process design Map existing process at representative sites, including the steps involved and the business reason for each step Review the issues of current practice, best practice guidelines, and lessons learnt Develop a standard Pan cluster ‘as is’ process map, highlighting areas of variation Review of the ‘as is’ process map Pan Cluster, identifying areas of difference and similarity. Are the differences significant or can they be managed locally Design new process considering current issues, best practice, and lessons learnt Highlight differences in the process across Cluster. Highlight issues to be addressed by process redesign Review of best practice process Pan Clusters Updating of best practice process to reflect comments from Pan Cluster review Existing best practice Identify existing best practice guidelines, both national and local Implementation Identify areas of expertise and good practice within London/the South and from other Clusters Implementation of best practice process alongside the technical solution with consideration of the local and professional user requirements Develop advice on ‘lessons learnt’ from sites who have previously Implemented similar systems with process redesign What needs to be done?

21. Formation of steering group Including CCA, NPfIT and NHS. Initial Best Practice Workshop Detailed Process Output Initial High-level Principles Iterative BPPDG and Review Groups Workshop Output Write-up High-level Process & Definition Principles Detailed Process Output Best Practice Approach

22. “Sealed Envelope” Principles • Some investigations are sensitive before resulted • Patients may give or remove consent for data “unsealing” at any time • Patients may give consent for all data to be “unsealed” • The Clinician may need to make the patient aware of the potential clinical implications and risks of their request

23. “Sealed” Principles (contd) • Users will know if there is “sealed off” data from any system • The Patient may not select to “seal” data whose absence may lead to the degradation of the Care Process • The Clinician has veto on the restricting of data e.g. where there is risk to others

24. Pre Sealed Envelope Post Sealed Envelope Consent is on or off (Record/Organisation) Consent on or off for elements or whole record Show message data view to clinician (and patient) Show message data view to clinician and patient 1 Send and allow access 1 Send and allow access 2 Send and switch off access 2 Send and switch off access Return to record and amend 3 Send and put data in sealed envelope Return to record and amend Different Scenarios Radiology Reports – P1R2 Pathology and Radiology Requests – P2R1 Sealed Envelopes – P2R2

25. Requests & Results – The Sealed Envelope

26. Requests & Results – The Sealed Envelope

27. Benefits Realisation Best Practice Engagement IDX Product Development Communication, Organisation & Cultural Change Finance Service Business IDX Tec IT Spaient Consulting BT Requirements Solution Design Solution Development Testing Deploy Service Benefits Realised Contract Environment Design Build Deploy Operate PREDEPLOY: Training, Legacy, Infrastructure, Integration PMO / Exec / Operations Programme Approach