The National Programme for IT

1. The National Programme for IT or NPfIT One year further on and the National Audit Office Report Stephen Balmer CPD4IT (Scotland) Meeting 8th November 2006 Wishaw General Hospital

3. Retrospect • The update • What about Laboratories?

4. What is the Purpose of the Programme? • Huge volume of contacts between NHS and patients generating reams of paper records, reports and information. In a typical week; • six million people will visit a GP, • 360,000 people will have an x-ray, • 250,000 people will attend their first outpatient appointment, • pharmacists will dispense some 13.7 million items on NHS prescriptions. • Procurement and development of IT within the NHS has been haphazard creating silos of data on individual systems. • The Programme is an opportunity to use IT to reform the way the NHS in England uses information to improve the provision of health services to patients.

5. What is the Programme & how is it organised? • National projects providing services for the whole of England. • New National Network – N3 • National Data Spine – NHS Care Record Service • Choose and Book • Local Service Providers (LSP’s) responsible for delivering the services within their particular part of the country. • Providing and maintaining local NHS Care Records Service • PACS solutions which connect to the National Spine in accordance with the NHS Care Record Service specification.

6. Programme Organisation - Clusters North East, Yorkshire & Humberside (Accenture/CSC) 7.5m Population 170,000 NHS Staff North West & West Midlands (Computer Services Corporation) 12.3m Population 276,000 NHS Staff East & East Midlands (Accenture/CSC) 9.5m Population 174,000 NHS Staff London (British Telecom) 7.2m Population 165,000 NHS Staff South (Fujitsu) 13.1m Population 249,000 NHS Staff

7. Programme Organisation - CfH Department of Health (DoH) Connecting for Health (CfH) National Infrastructure Service Provider (NISP) National Application Service Providers (NASPs) National Programme for IT (NPfIT) Cluster Cluster Cluster Local Service Provider (LSP) Local Service Provider (LSP) Local Service Provider (LSP) Strategic Health Authority Strategic Health Authority Strategic Health Authority NHS Trust NHS Trust NHS Trust NHS Trust

8. Electronic NHS Care Records Service – CRS (Spine), N3, e-mail and Contact • Detailed Care Record – Records of individual clinicians recording their episodes of care. • Summary Record – NHS Number, name, date of birth, address, allergies, adverse drug reactions, major treatments (historic and ongoing). A summary record for first line care. • Reduced administration and duplication of record keeping • Securely accessible by Healthcare Professionals with Legitimate Relationship with patient. • Patient can choose to limit their participation. • Lynchpin and enabler for other key NPfIT components • Safe, secure, encrypted e-mail and e-mail address book

9. Choose and Book - CAB • Realtime booking of hospital appointments allowing patients choice of date, time and place. • Patients can walk away from GP surgery with appointment notification. • Post consultation online or telephone facility to allow patients to make any required arrangements before selecting their hospital appointment. • Vast improvement in the time taken for hospital appointment over traditional paper trail mechanism. • Should significantly reduce ‘did not attends’

10. Electronic Transmission of Prescriptions - ETP • Prescriptions generated electronically and recorded in the patient’s CRS • Patient can nominate a Pharmacy and the electronic prescription will be automatically sent there. • ePrescription can be issued if patient wishes and which can be taken to any Pharmacy. • Far safer for patient by virtue of electronic transfer or barcoded details. • Benefit for Pharmacist in online reimbursement requesting after dispensing. • Simplification of Repeat Prescription requirements. • Integration with decision support system to assist clinician prescribing options.

11. Picture Archiving and Communication System – PACS (RIS) • Images available to all legitimate clinicians through CRS allowing current diagnosis and chronological review. • Digital images of x-rays and scans available for distribution allowing common view of information for clinician and care team discussion across large geographical distances. • Speedier diagnostic service with removal of manual processing delay of film based imaging. • Safer and more efficient working environment for Radiography staff – film is heavy and processing requires unfriendly chemicals. • No more cancelled operations or procedures due to loss of or unavailability of diagnostic images. • Digital technology significantly reduces patient exposure to radiation.

12. So, what progress on last year - deployment • By 3rd April 2006, the Programme had achieved the following; • 7,639 Choose and Book deployments • 1,153 Electronic Prescribing Service deployments • 9 Acute Patient Administration System Deployments • 10 Mental Health Patient Administration Systems • 17 Community Hospital Patient Administration Systems • 106 Community Care Systems • 30 Picture Archiving and Communication Systems deployments • 607 other system deployments such as GP systems etc. • Ongoing Implementation activity per month (CfH figures) • 3 Patient Administration Systems • 500,000 Patient Records converted and cleansed • 200 NHS sites have systems upgraded • 600 new N3 connections • 14,000 smartcards issued • 1,700 site visits in planning deployments • 6 Picture Archiving and Communication Systems implemented

13. So, what progress on last year - utilisation • By 3rd April 2006, the Programme had achieved the following; • 726,843 prescriptions issued using EPS • 261,893 Choose and Book bookings had been made • over 20 million images stored using PACS • 167,946 registered NHSmail users (80,000 are active?) • 14,130 new N3 connections have been made • 208,990 NHS staff have been registered for smart card issue • Ongoing Service Provision per month (CfH figures) • 8.5 million x-ray and other images stored • 15 million patient-related messages transmitted via spine • 1.8 million pathology results sent electronically to GP’s • 14 million e-mails sent using NHSmail • 600,000 letters issued electronically to patients • 1.3 million hits on Connecting for Health website • 100 terabytes of data transmitted via N3 network – around 4.5 billion written pages

14. In terms of the overall Programme • National Network – N3 implementation – providing rapid, robust and secure network across the NHS • Target 6000 sites connected by 31st March 2005 - achieved • Target 12,000 sites connected by 31st March 2006 – achieved 3 months early • Target all 18,000 sites connected by 31st March 2007 – 14,022 connected as at April 2006 (91.5% of total) and on target. • Total cost £530 million over 7 years.

15. In terms of the overall Programme • National Data Spine – Holds summary information about every patient. Controls access to patient records. Supports transmission of information between systems. Provides anonymised data for research and healt trend analysis. • Phase 1 Release 1 (P1R1) Development complete by June 2004, roll out complete by Dec 2004. This phase will install systems, hardware and software to form the framework to build future functionality including PDS, Transaction Messaing System and enabling technology for Choose and Book and Electronic Transmission of Prescriptions. • Parts of P1R1 went live June 2004 as planned but other parts were not implemented until April 2005, some 10 months late.

16. In terms of the overall Programme • National Data Spine – Holds summary information about every patient. Controls access to patient records. Supports transmission of information between systems. Provides anonymised data for research and healt trend analysis. • P1R2 – Development complete by Dec 2004, roll out complete by June 2005. More complex business and message handling processes including clinical situations. Includes full Choose and Book functionality, outpatient clinic letters, inpatient discharge summaries, report of the single assessment for elderly people, diagnostic imaging and pathology results, screening results, recording of care episodes and routing of some orders for some blood tests and diagnostic images. • P2R1 – Timetabled for development complete by June 2005 and roll out complete by Dec 2006. This phase was planned to add National Service Frameworks assessment and review record, secondary uses of spine data, planning and recording of the total care journey – integrated care pathways, full linking and electronic transfer of correspondence, pathology and image ordering and resulting and integration of dental services.

17. In terms of the overall Programme • National Data Spine – Holds summary information about every patient. Controls access to patient records. Supports transmission of information between systems. Provides anonymised data for research and healt trend analysis. • In Dec 2004, P1R1 and P2R1 releases were reorganised and replaced by a set of 5 software releases covering the functionality of these two releases, and the order in which functionality was to be delivered has been rephased. The revised set of releases for 2005 have been completed to the revised target. Release 5 was deployed from December 2005 but the payment to BT included a retention for the remaining defects within that release. Release 5 has since been delivered and paid for in full. • For 2006 and 2007, the number of spine releases will be limited to 2 functional releases per year which the LSP’s may take together if they would prefer. • In essence, some 2 years delayed. • Total cost £620 million over 10 years.

18. In terms of the overall Programme • Choose and Book – Initially to enable electronic booking of first hospital appointments for a patient at a date, time and place convenient to them. • Target for first booking June 2004. • Software delivered on time, first booking achieved July 2004. • Since then, however, uptake has been slower than expected and as of October 2005, was about a year behind schedule. • By 3rd April 2006, booking volumes were growing, but still only approximately 12% of all possible bookings were being made through the application. • Web based Choose and Book incompatible with Internet Explorer 7.0 • Total cost £64.5 million over 5 years

19. In terms of the overall Programme • NHSmail – E-mail and national directory service for all staff across all NHS organisations in England • Target – service available by October 2004 - achieved • Total cost £50-90 million over 9 years (depending upon useage)

20. In terms of the overall Programme • Electronic Prescription Service – transfer prescriptions electronically from GP’s and other prescribers to the chemist of pharmacist nominated by the patient and to the Prescribing Pricing Authority. • Target – first deployment by Feb 2005 - achieved • Target – Dec 2005, 50% of all sites should be capable of issuing Electronic Prescriptions and by December 2007 100% of all sites should be capable of issuing Electronic Prescriptions. • By March 2006, 1,034 (out of 8,298) practices were technically live (ie. able to switch on) and 296 were actually using the application. 148 community pharmacies were technically live and 11 were using the application. • Two of the ten pharmacy system suppliers had received ‘authority to roll out’ for their systems. • Although usage grows fairly rapidly (260,898 prescriptions by March 2006), there is much to do to meet the December 2007 target.

21. In terms of the overall Programme • Picture Archiving and Communications Systems (PACS) – provide systems to capture, store, distribute and display static or moving digital medical images, such as x-rays. • Target – full deployment of 130 PACS by March 2007 • Implementations delayed, however by April 2006, 30 PACS had been deployed.

22. In terms of the overall Programme • Local Service Providers – responsible for providing and maintaining the local NHS Care Record Service to all NHS care settings and for PACS solutions which connect to the National Spine in accordance with the NHS Care Record Service specification. • North Eastern Cluster – approximately 25 months behind schedule • London Cluster – approximately 14 months behind schedule • Eastern and East Midlands Cluster – approximately 21 months behind schedule • Northwest and West Midlands Cluster – on schedule with revised targets (most aspects revised to 12 months later) but with some functionality not being implemented until 19 months behind schedule. • Southern Cluster – approximately 18 months behind schedule • Total cost - £4998 million over 10 years.

23. Engaging the Users Ipsos MORI Survey – July 2005

24. What about Laboratories? • Well nothing…. but, • Authentication and Authorisation • Connectivity to the Personal Demographic Service (PDS) • Legitimate Relationship • Result reporting to Personal Spine Information Service (PSIS)

25. Authentication and Authorisation • Achieved via smart card access and NHS Userid Login • Authentication, identity of user • Authorisation, permission(s) to act in given capacities

26. Personal Demographic Service • The Personal Demogaraphic Service (PDS) is part of the NHS Care Record Service (NHS CRS), which will create an electronic care record for every NHS patient in England by 2010. • Each person’s electronic NHS Care Record will comprise both demographic information, such as name, address, date of birth and NHS number, and medical information. The PDS is the national, electronic database of demographic details. It will enable a patient to be readily identified by NHS staff and associated, quickly and accurately, with their correct medical details.

27. Legitimate Relationship • Exists between a patient and; • Workgroup(s), • Individual clinicians. • Only users within the Legitimate Workgroup can access the patient record.

28. Personal Spine Information Service • The Personal Spine Information Service (PSIS) is the central database containing clinical records for each NHS patient. The PSIS record provides an up to date summary of information and key events in a patient’s life and care – drug allergies, operations, conditions, medication history – as well as details of contacts with care providers. • When current treatment generates essential information for continuing care, such as discharge information or notes of visit to a walk-in centre, specified summary information is added to the PSIS record. In this way the person-based PSIS record gives information to, and receives it from, many local systems as the patient experiences healthcare.

29. Thank You !