Data Communications between the NHS and Independent Sector Clinicians in England

1. Data Communications between the NHS and Independent Sector Clinicians in England

2. Prof. Ricky Richardson BSc MBBS MRCP(UK) FRCP FRCPCH DCH DTM&H Consultant Paediatrician Visiting Professor of eHealth - Imperial College Director of Global eHealth Ambassadors Programme Chair, Independent Doctors Federation IT Committee 2

3. The Problem Registries Clinics Home Care Hospitals Labs Primary care 3 Tertiary Care

4. Independent Doctors Federation 4 • Formed in 1989 as a Forum, became the Federation in 2009 • Represents independent doctors in all matters relating to private medicine, education, appraisal and revalidation. • Currently 1000+ members • 67% Consultants, 33% GPs • 43 corporate sponsors • Supports excellence in independent medical practice • Seeks to influence Government and regulators in all aspects of independent medical practice.

5. IDF IT Committee 5 IDF IT Committee was reconvened in 2009 and asked to establish: • What IT systems are currently being utilised by practitioners and small specialist clinics within the independent sector • Which IT systems are being utilised by the current major independent sector providers. • Develop active links between Independent Sector and the Department of Health to define a process for patient data held under the NHS to be more readily available to the independent sector, and vice versa

6. IDF IT Committee 6

7. Research & Analysis 7 • Survey of IDF members • Online questionnaire, 80+ responses • Additional discussions with: • Independent Providers & Practitioners • System Suppliers • Defence Medical Services • Great Ormond St Hospital for Children NHS Foundation Trust

8. Research & Analysis 8 72% use software to manage practice

9. Research & Analysis 9 23% use custom or no software to manage practice

10. Research & Analysis 10 Some survey respondents used more than 1 method 92.5% of respondents exchange patient information with NHS using a variety of means

11. Research & Analysis 11 • The vast majority of independent doctors have no means of exchanging data electronically with the NHS • Only 5.7% claim to have some form of network connection

12. Research & Analysis 13 83.6% of respondents did not know if their practice management system complied with current NHS requirements for secure data transfer.

13. Research & Analysis 12 Source: Survey of IDF Members The impact on patient care arising from an inability to exchange patient information

14. Report Conclusions 14 • Serious lack of integration between NHS and Independent Sector IT systems • Absence of a clear NHS strategy for systems that permit data sharing • Need for co-operation between state and private sector organisations to create a cost effective mechanism for clinical data exchange • between "qualified providers" notably those with smaller practices • Potential benefits for a move towards a culture of shared ownership of data (and risk) between clinicians and patients

15. Recommendations 15 • Engage with DH to: • Facilitate access by Independent Doctors to the NHS National Network • Work to agree common standards for the exchange of patient data with NHS systems • Help raise awareness of confidentiality and security requirements affecting patient information and data transfer • Encourage adoption of electronic practice and clinical management systems by the Independent Sector

16. Recommendations 16 • Set up a Clinical Expert Working Group: • To study information pathways in various patient constituencies with similar issues and barriers • Illustrate practical problems and viable solutions

17. Next Steps 17 • Produce evidence through case studies: • Care for Service Personnel • Care for Paediatrics/Children • Care for the Elderly • Care for Offenders

18. Care of Service Personnel 18

19. Casualty Analysis & Reporting 19

20. A Personal Experience 22 “We were all issued with morphine. You self-administer that the moment you're injured. There was a good chance you'd arrive at Camp Bastion conscious but delirious. And certainly bewildered and shocked. You'd quite possibly then be sedated and not wake up until you arrived in Selly Oak in Birmingham”. David Cotterell, Artist

21. Patient Journey Overview Casualty • Transfer to Camp Bastion, Helmand, Afghanistan • Field Casualty Stabilisation • Airlift transfer to UK hospital • Rehabilitation 20

22. British Casualty Rates - Afghanistan 23

23. British Casualty Figures in Afghanistan 24 1 January 2006 to 28 February 2013 (Source: www.gov.uk)

24. Issues 21 • Inpatient care when necessary is provided by the NHS, contracted by the MoD • Longer term mental health care contracted to independent sector • Issues faced by the Defence Medical Services in dealing with the NHS: • lack of standards to provide a common language for communications between systems • inconsistencies in process, e.g. payments for cases

25. Care of Paediatrics/Sick Children 25

26. Care of Elderly 26

27. Care of Offenders 27

28. Case Study Objectives 28 • Review all activities that contribute to the treatment and pathways of care in the immediate and long term • Identify the information flows required at each stage of treatment along the pathways of care • Identify and understand all existing or potential barriers which prevent the timely or efficient transfer of patient information in any format between practitioners at each stage • Comment and draw conclusions on the findings of the study • Suggest appropriate modifications to current practice and make recommendations for their implementation (in areas which might include process, system interoperability, information governance and information management)

29. Independent Expert Working Group 29 • Part of Imperial College iHealth initiative • Chaired by Prof Dick Kitney, Professor of Biomedical Systems Engineering • To include IDF and other contributing partners • Issues are wider than original remit

30. Patient-held Records Policy 30

31. No Barriers – Less Risk Registries Clinics Home Care Hospitals Labs Primary care 31 Tertiary Care

32. In Summary 32 No policy on sharing patient data between systems Freeing-up commissioning is valid but patient safety is compromised because systems don’t talk Current IT systems use proprietary not open architectures Moving to a patient-held record environment with patient-specific apps.

33. Learning To Share 33

34. 34 Prof Ricky Richardson Email: rjrichardson@btinternet.com Office Tel: 0208 742 0186