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The National Programme for Information Technology in the NHS
INFORMATICS
The National Programme for Information Technology in the NHS
it is at the time of writing being rolled out throughout the country. Detailed Care Record This is the local clinical record and consists of the following components: patient administration system (PAS) scheduling electronic requests and reports assessments/noting/care pathways clinical correspondence electronic prescribing decision support clinical reporting. Local Service Providers (LSPs) were appointed by the programme and the delivery of these systems is well behind the original targets. In the North Midlands and East of England Computer Science Corporation (CSC) is implementing a new system, (iSoft Lorenzo) which is now live in one acute trust. In London BT have made some headway with implementing an American system (Cerner Millennium) which is also deployed in some trusts in the South.
Chris Barham
Abstract The National Programme for Information Technology (NPfIT) was established in 2002 to deliver modern information technology to NHS clinicians in England. Whilst many aspects of the programme have been delivered successfully, 8 years later the vision of the ability to share a patient’s record whenever required for efficient patient care has yet to be realized. Whilst GPs have for some time had good electronic record systems, hospitals have for the most part lagged far behind.
Keywords Electronic patient records; National Programme for Information Technology; NPfIT; NHS Connecting for Health
Other systems Despite the slow progress in implementing electronic records there are numbers of supporting and complementary programmes that have been successful and are now delivering benefits. These are listed in Box 1. One of the first aims of the programme was to enable patients to have more control over their referrals through an electronic booking system. The facility for choice was then added to the system (Choose and Book) which highlighted one of the recurrent issues with such a large programme, namely the ability to incorporate policy changes into existing systems.
Good technological support is essential for safe efficient and effective delivery of healthcare. In 2002 this was recognized by the then UK government which convened a meeting chaired by the Prime Minister that gave birth to the National Programme for Information Technology (NPfIT). This just covered England as Scotland Wales and Northern Ireland have had their own programmes. The vision was ambitious as the country’s largest investment in information technology and was to be delivered by 2005.
Electronic records The principal feature of the programme, delivered by NHS Connecting for Health, was to have electronic records available to both healthcare professionals and patients to improve communication efficiency and safety. This required the creation of robust standards and a secure broadband network with an architecture for authentication consent and confidentiality. This last aspect has been the focus of concern and one of the first standards was the development of the Care Record Guarantee (see article on Confidentiality and security in this issue). The electronic record service consists of a national service e the Summary Care Record and local systems e the Detailed Care Record e for each organization.
NHS Mail has been another important component of the programme as it provides secure transmission of patient information. Perhaps the most significant system for secondary care has been Picture Archiving and Communications (PACS). This provides electronic delivery of medical images and has been successfully implemented throughout the country. Whilst providing clear benefits within organizations there have been issues when trying to transfer images between different organizations or different parts of the country. These have been both technical (due to different systems) and legal (to ensure compliance with information governance) and have now been largely overcome.
Summary Care Record This is intended to make key items of information available wherever required. Currently this includes medications, allergies and key medical interventions. After several pilots of the scheme
Recent developments In 2008 the Health Informatics Review was published to complement Lord Darzi’s Next Stage Review. Part of this was to consider the priorities for clinical systems in acute hospitals, and it listed five key components that clinicians considered as the minimum specification of functionality for secondary care. These elements are known as the ‘Clinical 5’ (Box 2) and the review urged local programmes to identify the roadmap to achieve these as soon as possible. In the South of England,
Chris Barham FRCA is Consultant at the Queen Victoria Hospital, East Grinstead, UK. He has been interested in electronic records for many years, and is a past President of the Society for Computing and Technology in Anaesthesia (SCATA). He is Clinical Lead for the Southern Programme for Information Technology (SPfIT). Conflicts of interest: none.
ANAESTHESIA AND INTENSIVE CARE MEDICINE 11:12
507
Ó 2010 Elsevier Ltd. All rights reserved.
INFORMATICS
Systems delivered by Connecting for Health C
Choose and Book A national electronic referral service which gives patients a choice of place, date and time for their first outpatient appointment in a hospital or clinic.
C
NHS Mail The secure email and directory service for NHS staff in England and Scotland, approved for exchanging patient data with other NHS Mail and Government users.
C
PACS Picture Archiving and Communication Systems (PACS) enables images such as X-rays and scans to be stored electronically and viewed on screens, creating a near filmless process and improved diagnosis methods.
C
EPS Electronic Prescription Service (EPS) enables prescribers e such as GPs and practice nurses e to send prescriptions electronically to a dispenser (such as a pharmacy) of the patient’s choice.
C
GP2GP Enables patients’ electronic health records to be transferred directly and securely between GP practices.
C
N3 The National Network (N3) provides fast, broadband networking services to the NHS, offering reliability and value for money.
C
SUS Secondary Uses Service (SUS) is the single source of comprehensive data to enable a range of reporting and analysis.
C
QMAS Quality Management and Analysis System (QMAS). A national IT system which gives GP practices and primary care trusts objective evidence and feedback on the quality of care delivered to patients.
C
The Clinical 5 1. Patient administration system (PAS) with integration with other systems and sophisticated reporting. 2. Order communications and diagnostics reporting including all pathology and radiology tests and tests ordered in primary care. 3. Letters with coding including discharge summaries, clinic and Accident and Emergency letters. 4. Scheduling for beds, tests, theatres, etc. 5. Electronic prescribing including ‘To Take Out’ (TTO) medicines.
Box 2
where there was now no LSP after the departure of Fujitsu from the programme, the aim has been to procure systems through the Additional Supply Capability and Capacity (ASCC) programme. This should allow the procurement from an approved list of suppliers of elements already in use in the NHS or equivalent environment. All programmes are at the time of writing under review, but the July 2010 Government White Paper proposes an NHS information revolution including patient access to their own records.
Anaesthetic records Electronic records for anaesthesia and critical care were part of the original specification for the National Programme. However as time has passed and even the basic elements are many years behind schedule the scope has inevitably contracted. This is unfortunate as there are clear benefits of anaesthetic systems. These include real-time recording of physiological and machine data and the ability to ensure drugs administered in theatre are present in the main Medicines Administration Record which can help to eliminate duplicate administration. However even without dedicated anaesthetic and critical care systems there are many benefits to anaesthetists and their patients. The ability to review previous history, medications, adverse reactions and current investigations prior to meeting the patient can improve the efficiency and safety of our practice. A
NHS Care Records Service (NHS CRS) Electronic patient records Locally held detailed records in primary and secondary care.
B
B
B
Summary Care Record A national (in England) database of key information such as drugs and allergies.
FURTHER READING Department of Health. Health informatics review, www.dh.gov.uk; 10 July 2008. Department of Health. Equity and excellence: liberating the NHS, www.dh.gov.uk; July 2010. IT Policy Review Group. Independent review of NHS and social care IT, www.conservatives.com; 2009.
My HealthSpace Portal for patients to view and in some circumstances contribute to their health record.
Box 1
ANAESTHESIA AND INTENSIVE CARE MEDICINE 11:12
508
Ó 2010 Elsevier Ltd. All rights reserved.
The National Programme for Information Technology in the NHS
it is at the time of writing being rolled out throughout the country. Detailed Care Record This is the local clinical record and consists of the following components: patient administration system (PAS) scheduling electronic requests and reports assessments/noting/care pathways clinical correspondence electronic prescribing decision support clinical reporting. Local Service Providers (LSPs) were appointed by the programme and the delivery of these systems is well behind the original targets. In the North Midlands and East of England Computer Science Corporation (CSC) is implementing a new system, (iSoft Lorenzo) which is now live in one acute trust. In London BT have made some headway with implementing an American system (Cerner Millennium) which is also deployed in some trusts in the South.
Chris Barham
Abstract The National Programme for Information Technology (NPfIT) was established in 2002 to deliver modern information technology to NHS clinicians in England. Whilst many aspects of the programme have been delivered successfully, 8 years later the vision of the ability to share a patient’s record whenever required for efficient patient care has yet to be realized. Whilst GPs have for some time had good electronic record systems, hospitals have for the most part lagged far behind.
Keywords Electronic patient records; National Programme for Information Technology; NPfIT; NHS Connecting for Health
Other systems Despite the slow progress in implementing electronic records there are numbers of supporting and complementary programmes that have been successful and are now delivering benefits. These are listed in Box 1. One of the first aims of the programme was to enable patients to have more control over their referrals through an electronic booking system. The facility for choice was then added to the system (Choose and Book) which highlighted one of the recurrent issues with such a large programme, namely the ability to incorporate policy changes into existing systems.
Good technological support is essential for safe efficient and effective delivery of healthcare. In 2002 this was recognized by the then UK government which convened a meeting chaired by the Prime Minister that gave birth to the National Programme for Information Technology (NPfIT). This just covered England as Scotland Wales and Northern Ireland have had their own programmes. The vision was ambitious as the country’s largest investment in information technology and was to be delivered by 2005.
Electronic records The principal feature of the programme, delivered by NHS Connecting for Health, was to have electronic records available to both healthcare professionals and patients to improve communication efficiency and safety. This required the creation of robust standards and a secure broadband network with an architecture for authentication consent and confidentiality. This last aspect has been the focus of concern and one of the first standards was the development of the Care Record Guarantee (see article on Confidentiality and security in this issue). The electronic record service consists of a national service e the Summary Care Record and local systems e the Detailed Care Record e for each organization.
NHS Mail has been another important component of the programme as it provides secure transmission of patient information. Perhaps the most significant system for secondary care has been Picture Archiving and Communications (PACS). This provides electronic delivery of medical images and has been successfully implemented throughout the country. Whilst providing clear benefits within organizations there have been issues when trying to transfer images between different organizations or different parts of the country. These have been both technical (due to different systems) and legal (to ensure compliance with information governance) and have now been largely overcome.
Summary Care Record This is intended to make key items of information available wherever required. Currently this includes medications, allergies and key medical interventions. After several pilots of the scheme
Recent developments In 2008 the Health Informatics Review was published to complement Lord Darzi’s Next Stage Review. Part of this was to consider the priorities for clinical systems in acute hospitals, and it listed five key components that clinicians considered as the minimum specification of functionality for secondary care. These elements are known as the ‘Clinical 5’ (Box 2) and the review urged local programmes to identify the roadmap to achieve these as soon as possible. In the South of England,
Chris Barham FRCA is Consultant at the Queen Victoria Hospital, East Grinstead, UK. He has been interested in electronic records for many years, and is a past President of the Society for Computing and Technology in Anaesthesia (SCATA). He is Clinical Lead for the Southern Programme for Information Technology (SPfIT). Conflicts of interest: none.
ANAESTHESIA AND INTENSIVE CARE MEDICINE 11:12
507
Ó 2010 Elsevier Ltd. All rights reserved.
INFORMATICS
Systems delivered by Connecting for Health C
Choose and Book A national electronic referral service which gives patients a choice of place, date and time for their first outpatient appointment in a hospital or clinic.
C
NHS Mail The secure email and directory service for NHS staff in England and Scotland, approved for exchanging patient data with other NHS Mail and Government users.
C
PACS Picture Archiving and Communication Systems (PACS) enables images such as X-rays and scans to be stored electronically and viewed on screens, creating a near filmless process and improved diagnosis methods.
C
EPS Electronic Prescription Service (EPS) enables prescribers e such as GPs and practice nurses e to send prescriptions electronically to a dispenser (such as a pharmacy) of the patient’s choice.
C
GP2GP Enables patients’ electronic health records to be transferred directly and securely between GP practices.
C
N3 The National Network (N3) provides fast, broadband networking services to the NHS, offering reliability and value for money.
C
SUS Secondary Uses Service (SUS) is the single source of comprehensive data to enable a range of reporting and analysis.
C
QMAS Quality Management and Analysis System (QMAS). A national IT system which gives GP practices and primary care trusts objective evidence and feedback on the quality of care delivered to patients.
C
The Clinical 5 1. Patient administration system (PAS) with integration with other systems and sophisticated reporting. 2. Order communications and diagnostics reporting including all pathology and radiology tests and tests ordered in primary care. 3. Letters with coding including discharge summaries, clinic and Accident and Emergency letters. 4. Scheduling for beds, tests, theatres, etc. 5. Electronic prescribing including ‘To Take Out’ (TTO) medicines.
Box 2
where there was now no LSP after the departure of Fujitsu from the programme, the aim has been to procure systems through the Additional Supply Capability and Capacity (ASCC) programme. This should allow the procurement from an approved list of suppliers of elements already in use in the NHS or equivalent environment. All programmes are at the time of writing under review, but the July 2010 Government White Paper proposes an NHS information revolution including patient access to their own records.
Anaesthetic records Electronic records for anaesthesia and critical care were part of the original specification for the National Programme. However as time has passed and even the basic elements are many years behind schedule the scope has inevitably contracted. This is unfortunate as there are clear benefits of anaesthetic systems. These include real-time recording of physiological and machine data and the ability to ensure drugs administered in theatre are present in the main Medicines Administration Record which can help to eliminate duplicate administration. However even without dedicated anaesthetic and critical care systems there are many benefits to anaesthetists and their patients. The ability to review previous history, medications, adverse reactions and current investigations prior to meeting the patient can improve the efficiency and safety of our practice. A
NHS Care Records Service (NHS CRS) Electronic patient records Locally held detailed records in primary and secondary care.
B
B
B
Summary Care Record A national (in England) database of key information such as drugs and allergies.
FURTHER READING Department of Health. Health informatics review, www.dh.gov.uk; 10 July 2008. Department of Health. Equity and excellence: liberating the NHS, www.dh.gov.uk; July 2010. IT Policy Review Group. Independent review of NHS and social care IT, www.conservatives.com; 2009.
My HealthSpace Portal for patients to view and in some circumstances contribute to their health record.
Box 1
ANAESTHESIA AND INTENSIVE CARE MEDICINE 11:12
508
Ó 2010 Elsevier Ltd. All rights reserved.