Information Management in Primary Care 7-8 November 2007 – University of Mauritius 1 Information Management in Primary Care Mike Sievwright

2 Mike Sievwright - Background Project Manager - Business Analyst - Information Consultant 25 Years experience of IT systems in both Health Sector and Commercial world Projects include Pharmacy Computer Systems, Government Websites and Risk Management Systems Since 2003 Working in NHS for Brent Primary Care Trust Using data from GPs and Hospitals How health service data is organised Applying IT solutions to make information more available

3 What is “Information Management”?

4 This is Information Management? How Information is  Obtained  Recorded  Held  Used  Shared

5 A Short History of IT development -Exponential pace of change in last 30 years -Originally Bespoke software built to order for high value businesses – -Since 1990, further developments come from personal computing, homegrown by enthusiasts -Reuse of software from one business sector to another -The development of specialism in particular business sectors -The development of highly integrated large scale systems for a specific business, or across business sectors

6 Why is Healthcare Information Management happening?  Industries such as Banking and Retailing have rapidly evolved IT - High degree of customer interaction  Sectors such as Transport, Insurance, Finance now have highly complex systems – fully dependent on technology for competitive advantage  In the last 20 years specialised healthcare systems have developed to improve effective care and reduce costs  Systems developing to involve the patient more  Patient Choice  The “Expert Patient”

7 Who are the Users of a Healthcare Information Management System? Why should a clinician use a computer system? Who else is a stakeholder in a Primary Care Healthcare computer system? The Patient? Other Clinicians? The Clinician’s Organisation? The Health Service or Government? Insurers? Pharmaceutical and other service suppliers Academics and Researchers?

8 Healthcare IT Evolution Driven By Needs or Driven by Technology?  Professionals adapt new technology to their personal use  Organisations develop solutions for their immediate needs to save time /money  Best practice is shared between professionals  Health Service management uses IT infrastructure to establish rules and regulation  Datasets  Electronic data interchange  Larger Organisation efficiencies by bigger, more complex systems?

9 What’s different about Primary Care? Primary Care units locally organised or self run More Patients, more prevention, less operations Smaller, more autonomy? Less use of technology and lower investment per capita State funding rather than insurance based Clinicians know more about the patients

10 Types of Healthcare Systems AdministrationClinical SharingGovernance Information Management Services

11 Administrative Systems  Appointment Management  Document Management  Scheduling Clinicians and Financial Records  Immunisation and Screening events  The PAS – Patient Administration System

12 Administrative Systems - the issues? Treating the patient as just a “customer” number Smart cards for staff and patients? Risks in Use of the Patient Identifier?

13 Clinical Information Management  Recording Diagnoses  Treatment events  Prescription records  Referrals  Allergies and drug reactions and interactions  Patient Safety and Clinical Governance  Patient History?  Family History?  Recording of effective/ineffective interventions and outcomes  Decision Support for clinicians  Why use Coding Systems?  The repository of patient history  Clinicians notes in shorthand transformed into a coded record  Mix of coding systems for Diagnoses Drugs Treatments Events and Tests Places and people The Read Code SNOMED

14 Issues regarding Clinical Information in Primary Care? What information should be recorded? Can there be a single coding system? Converting patient records from handwritten, or earlier systems? Ease of use by clinicians? Is any information missing? (could impact future decisions?) Same patient may have information in several different systems

15 Information Sharing - Islands of Information Funding GPHospitalResearchPharmacy

16 Benefits of Electronic Flows between healthcare services? No need to re-enter information from one system to another Improves accuracy and speed Single version of the truth Paperlight -> Paperless

17 Information Sharing – types of application  Prescriptions  Referral notes  Appointment records  Test results  Discharge notes  Text Message reminders Supporting Management and Financial flows Performance Management Governance and Regulation

18 Drawbacks and Risks of Information Sharing  Technical dependencies on experts  Complexity of systems needs significant management  Software suppliers want to lock in the customer  Connectivity and Interdependence can slow things down  Data replicated can become out of synch  Which version to believe?  Complex to keep updates in line  Personal data about Patients  The UK Data Protection Act  Regulation based on Caldicott report on Patient Identified Record sharing  Is information less secure in one large system than in many small ones?

19 Information Governance  Introducing InformationTechnology brings additional risks  Need to gather best practice, guidance and standards together  A programme of assessment and improvement  Imposed or Self Regulated?  Importance of controls on the flow of information  Data access  Responsibilities for retention and accuracy

20 Information Governance Needs Manage the risks of IT in health, including security and data quality Based on developing skills and good communication of guidance Act on errors in management, systems, training, misunderstood processes Poor quality information impacts on Clinical Care Disease Surveillance Medical Research Health Service Management

21 Getting Information Sharing to Work Top Down Single Supplier? Standard- isation Botto m Up Local Agreements Diverse Local Systems

22 National Programme for IT - Started 2003 – Now known as “connecting for health” 10 Years - Initially £8 Billion – 30,000 GPs and 300 Hospitals Mix of “suppliers” based on nationally agreed design criteria, commercially negotiated “The biggest IT project in the world” Complex management of projects at local and national levels Migration from “the Legacy” a complex issue “The Spine” – Electronic Patient Care Record “The Portal” “The NHS network” Electronic Prescriptions New GP Systems Digital Imaging Exchange PACS Choose and Book

23 Benefits Realisation New Systems are not guaranteed to solve problems Is investment in IT a hit or miss affair? Clinicians may regard an Information Management system unfavourably Getting in the way of care for the patient Too complex a solution that will never work Teething troubles are never sorted out Health Economic programmes may have many “facets” of cost and benefit Needs to be driven both by financial effect and by improvements in care For every $ (£) on IT, spend 10x $ (£) on people

24 Will an Information Management System be IT driven or IT enabled? Rationalisation of Hardware Reconfiguration of Support Services Networking and Web sites IT Driven Shared Electronic Care Records Prescribing and Ordering Tests Booking services Decision support and alerts IT Enabled

25 Conclusion - Developing Information Management Development & Innovation Incorporate Best Practice Refinement and Change Management Widespread Use

26 Important Questions Do (all) clinicians want or need Information Management? Who are the users of a Healthcare Information Management System – how do their needs differ? Where are the boundaries where information flow needs to be controlled? What are the different types of use of Information Management Systems? Will a Top Down approach work? Is a Single Central Health record essential? If you have multiple systems, will it be complex to integrate later? What is the best approach to procuring new systems? How to manage Information Governance? IT led or IT enabled? – Driven by Technology or Needs? Can you realistically estimate the benefits (business case) in large scale change programmes?

References on the Internet Connecting for Health – the UKs National NHS computer project The NHS Information Centre – Central source of reference material Read Coding - Developing coding skills in GPs – the Primis service Information Governance – toolkit approachhttp:// msandservices/infogov UK Hospital Episode Statisticshttp:// E-Learning – Essential IT Skillshttp:// 27