1. The Integrated Care Record Service - a Local Trusts Perspective Peter Knight Head of IM&T Winchester & Eastleigh Healthcare Trust

2. Session Objectives What is ICRS? Does ICRS exist at present? How will ICRS effect NHS Trusts? Can the IT industry cope? Questions and Answers

3. Secure Broadband National Data Standards & Data Interchange Stds Based on Open Technology National Services for NHS IT Architecture – Consent, Authentication, Confidentiality Provide Bookings Service ICRS Provide Prescriptions Service Partner with Industry to deliver Open systems & Clinical applications National Direction - Funding, Procurement ICRS Context

4. What is ICRS? In records terms it is Patient focused not organisational! NHS organisation holds multiple patient records, not a truly shared record? Common integrated functionality PAS, Order Communications, Pharmacy, PACS, etc. Common integrated reference material SNOWMED CT, ICD 9/10, Formulary, Knowledge bases, etc Specific functionality for: Primary Care, Community Care, Secondary Care, Tertiary Care, Mental Health and Social Services, etc

5. ICRS phases of delivery Phase 1: (2003 - 2004) Nationally delivered thin patient record spine with viewing functionality only! (e.g. view only EHR) Functionality is mainly around infrastructure and nationally available applications and knowledge! Phase 2: (2004 - 2006) Depth of patient record spine increased Rollout of new and enhanced systems in the local health economies (e.g. documentation for multi-disciplinary assessment) Further support for information management and workflow Extension of nationally delivered applications

6. ICRS phases of delivery (cont) Phase n: (2006 - 2010) Enhanced patient centric facilities (e.g. patients able to contribute to their own record) True representation of the patient journey (e.g. ICP linked to structured documentation) Local data will be delivered using national services Increased capability to support new functionality (e.g. cancer networks) Focus on patient based self monitoring, using new technology systems(e.g. remote monitoring etc)

7. Does ICRS exist? Manual Systems - Perhaps in Concept Yes Multi-disciplinary documentation exists within some teams but rarely across care settings Electronically - No EPR and EHR systems exist that are a limited subsets of ICRS for specific geographies Commercial products are not ICRS compliant, as they are based upon organisational concepts (EPRs) Integration engines are just glue and have high costs of ownership and potentially lead to poor data quality

8. How will ICRS effect NHS Trusts? Today? (not so good news) Information services and clinical application development will falter! (awaiting Local Service Provider contracts) Trusts strategies will need to be re-aligned! Trusts will need to focus on infrastructure! Cessation of local procurements resulting in increased organisational risk. Tomorrow? (good news) Establishment of a core patient record Integrated clinical applications Agility in service delivery Improved data quality and information management Beyond (blue sky) Patient partnership in care information management

9. So what about my local Trust? Healthcare Information System The replacement of a 14 year old EPR level 4/5 Local Output Based Specification (OBS) is built upon the ICRS OBS Outline Business Case (OBC) focuses mainly on strategy and benefits Other initiatives Need to pump prime the change management that will be required for ICRS delivery Managing expectation of Trust staff. Consolidation of outlying information sources

10. Can the IT industry cope? Technology - (Yes) We know that the technology required to deliver ICRS exists, but needs standardising! Industry does technology well Implementation (Mixed) Scale - can they cope with the volume and diversity of the NHS? Scope - can they pull together products that will deliver ICRS? Client Management - will industry be able to manage the NHS? Change management (No) The NHS is complex set of organisations Patient are individuals who don’t necessarily fit into defined processes

11. Questions & Answers