An Information Strategy for the modern NHS and relevance to the health system context of the Russian Federation WB Seminar on Health Information Systems, Moscow, Russian Federation Y.Samyshkin, A.Timoshkin Centre for Health Management The Business School Imperial College Based on: Information for Health, NHS National Information Authority 02/02/2004 1
Themes for discussion Strategy and institutional arrangements for information systems in the UK NHS National health information systems infrastructure Health information systems and the need for standards Information and effective management Needs of patients and population Implementation principles Relevance for the context of the Russian health system 2
UK Health System National service Tax financed Provided through the NHS Primary and secondary care NHS Hospital Trusts and PHC Trusts Per capita allocation of financing Health reform context: the New NHS 3
The basis of the information strategy An information strategy for the NHS must be driven primarily by a careful and comprehensive analysis of the information needed to support the service objectives of the NHS and the policy objectives of Government, and not simply by the technical possibilities. Adapted from: Information for Health, NHS National Information Authority 4
NHS IS Strategy Goals To ensure that information is used to help patients receive the best possible care To ensure that patients, carers and the public have the information necessary to make decisions about their own treatment and care Means lifelong electronic health records for every person in the country Round-the-clock on-line access to patient records and information about best clinical practice Fast and convenient public access to information and care Provision of information for the effective use and management of NHS resources Adapted from: Information for Health, NHS National Information Authority 5
Key Policy Documents National policy programme Our Healthier Nation The new NHS: Modern, Dependable Social Services White Paper Comprehensive Spending Review NHS Charter Working Together Health Information Information for Health - priorities: Collaboration between the NHS, Local Authorities in order to improve health Preparation and evaluation of Health Improvement Programmes Development of Primary Care Groups Improving the quality of care and supporting clinical governance 6
An integrated model for information National strategy Local implementation Treatment and care Primary Care EHR Social Care Records NHS Trust EPR Analysis Public health Clinical governance Health improvement programme Managers Knowledge for Public Patients Healthcare professionals Managers Adapted from: Information for Health, NHS National Information Authority 7
Information technology areas Telephone-based services such as NHS Direct A single gateway for all services Individualised personal electronic records On-line services will be provided for GPs and their patients Hospital appointments Reducing paperwork Telemedicine and telecare Communication between GP and hospitals Reducing referrals and travel Unobtrusive supervision for vulnerable people Integration of systems 8
Strategic objectives of the NHS IS To provide rapid 24-hour access for NHS professionals to the relevant personal information necessary to support their care To eliminate unnecessary travel and delay for patients by providing remote on-line access to services To provide access for NHS patients to accredited, independent, background information and advice about their condition To provide NHS professionals with on-line access to the latest local guidance and national evidence on treatment, and evaluation of effectiveness of clinical work To ensure the availability of accurate information for managers and planners To provide convenient access for the public to accredited advice on lifestyle and health, and information to support public involvement in local and national health service policy development. Adapted from: Information for Health, NHS National Information Authority 9
Information objectives supporting the key groups For professionals Reliable and rapid access to patient information On-line access to local and national evidence for treatment Access to effectiveness information 1 Clinical administrative data Patient administration and independent departmental systems For patients Accredited independent information Provision of on-line access to services and specialists Information objectives supporting key groups For the public Fast, convenient access to accredited information Involvement in health service policy For managers and planners Availability of accurate information for planning purposes Adapted from: Information for Health, NHS National Information Authority 10
Specific targets Network security agreements Electronic patient records first developments Integrated clinical systems Encourage facility based systems NHSDirect to the whole population Local costed health information strategies National Electronic Library for Health 11
Supporting Patient Care 02/02/2004 12
Electronic records - definition Mental health services Electronic Patient Record Hospital based Electronic Patient Record Primary care Electronic Health Record Community services Electronic Patient Record Social care Records Adapted from: Information for Health, NHS National Information Authority 13
Challenges Protecting privacy Ensuring data quality Integrated EPR meeting local needs at each care provider level Seamless care Information for the primary care teams Mutual access for social and medical services The need to develop information standards (common structure of records, definitions, etc.) Open systems Modernising the existing systems The need for a national programme 14
Levels of the NHS HIS 6 5 4 3 Advanced multimedia and telematics Telemedicine, other multimedia applications Specialty-specific report Special clinical models Clinical knowledge and decision support Electronic access to knowledge bases, embedded guidelines, rules, electronic alerts, expert systems Clinical activity support Electronic clinical orders, results reporting, prescribing, multiprofessional care pathways 2 1 Integrated clinical diagnosis and treatment support Integrated master patient index, departmental systems Clinical administrative data Patient administration and independent departmental systems Adapted from: Information for Health, NHS National Information Authority 15
Technology to support electronic patient records Sharing information Integrating data at source Integration of resultant information Hybrid approach Data-push and data pull The role of standards and development of standards Compatibility and standardised messaging for data exchange Open systems and rapid application development Browser-based applications 16
Supporting integrated care through NHS-wide standards and infrastructure 02/02/2004 17
National HIS infrastructure NHSNet and cost of its development and support The NHS-wide Clearing Service (NWCS) The NHS Strategic Tracing Service (NSTS) Clinical Terms licences The strategic messaging service FHS Exeter core systems The National Library for Health and accreditation of information Clinical decision support systems Management Information Systems (MIS) 18
National Infrastructure framework National information standards Procurement Information management Confidentiality protocols Record structure Clinical terms Clinical messaging Application level communication Networking Network and applications NHS-wide clearing service NHS strategic Tracing Service NHS Number NHSNet National electronic library for health Adapted from: Information for Health, NHS National Information Authority 19
Infrastructure projects, corporate communication network NHSNet, NHSWeb Adapted from: Information for Health, NHS National Information Authority 20
Why standards? Some current problems The lack of common record structures and terminology The absence of comprehensive nationally agreed standards and protocols for the capture and communication of clinical information professional and public concerns over the security of information in EPRs and EHRs The uncoordinated approach to developing conditionspecific clinical minimum data sets Practical difficulties in providing mutual access to patient/client records between health and social care The lack of a universal coded drug dictionary 21
Development of standards Exchange Privacy and security Access Library Standards National Health Information Infrastructure Unique NHS patient number Developing Clinical terms NHS-wide networking standards NHS-wide clearing house Guidelines on record keeping National electronic library for health 22
Developing clinical information standards Clinical headings and definitions Clinical terms and coding E.g. Read Codes, Clinical Terms v.3, SNOMED Classification Clinical products reference codes Casemix development Clinical messaging standards Condition-specific clinical data sets (e.g., for the cancer information strategy) Standard clinical record structures Security issues 23
Sources of information systems for healthcare Suppliers of systems Reputable Affordable Reliable Environment Market with government regulation 24
Information for improving health and more effective management 02/02/2004 25
Improve the flow and use of information improve data quality Improve information support of public health interventions establish quality and support clinical governance arrangements support local Health Improvement Programmes deliver the National Framework for Assessing Performance support National Service Frameworks 26
Issues with the management and quality of information a backlash to the collection of information that supports only management needs a perceived failure of the centre to limit the amount and type of information collected to that appropriate to national needs a failure to feed back useful analyses to those from whom information is collected no incentives to collect good quality data and in some cases perverse incentives to provide inaccurate and untimely data to avoid censure for poor performance. 27
Meeting public and patients' needs 02/02/2004 28
Meeting users needs Improving patients services through technology Improving public access to information on health and health services The local agenda Centre for health information quality 29
Information for users: NHSDirect online service http://www.nhsdirect.nhs.uk 30
National Electronic Library for Health 31
Making it happen 02/02/2004 32
Critical success factors A national consensus on the objectives to be achieved Effective and continuous dialogue between stakeholders Centrally mandated deliverables within specified timescales The development and application of a policy for key information management and technical standards Integrated local implementation of the National Information Strategy Performance management 33
National and local coordination National level Stakeholder input Policy development National programme management Performance management National mandated procurement process, supplier relationships Local level Local implementation strategies rather that organisation-specific uncoordinated developments Costed implementation plan Skills and resource development Legacy systems 34
Challenges in implementation An impression that IMG was remote from the service and that the former national strategy aims were not relevant to local operational realities Resentment about local charging for access to the national IM&T infrastructure A reluctance to mandate local compliance with national strategic objectives The poor quality of recorded clinical data, resulting in a relative lack of appropriate information for public health or managerial purposes Well publicised "failures" which have created a mythology of disaster around IM&T in the NHS The complexities of the IT procurement processes An insufficiently understood and committed informatics culture A lack of understanding amongst many NHS managers that information and information technology is a critical Chief Executive issue and is not the preserve of the IT specialists A failure to appreciate the full potential of radical changes in working practices made possible by modern information technology. 35
Discussion Themes relevant to the development of HIS in the Russian Federation 02/02/2004 36
Policy aspects Federal information strategy linked to sector development strategy Managing the multi-stakeholder environment Coordination between Federal and regional developments Addressing the variety of regional contexts Development and maintenance of Federal rules (standards) for the common use Inter-agency collaboration and integrating the existing health sub-systems Possibility to achieve changes through information Addressing data confidentiality 37
Economic / Social Investment in health information systems Investment in communication systems Level of financing of health care Market for information systems and market for IS in health care Government role in regulation of the IS market Link of clinical and economic information to decision making Supply and retention of human resources for health information systems Acceptance by health care professionals and sector managers 38
Technological Underdeveloped ICT infrastructure Standards, national and international Market for systems Disease-specific systems and core health information systems Data collection vs. data analysis and decision support Link of economic and clinical information for the purpose of service planning Unique user number Data confidentiality 39
Development strategy Core Federal arrangements Open standards, definitions, terminology build to form foundation Incremental development based on core systems No high-tech Legacy systems Analysis for sector development Feedback to health policy 40