1. The Health Informatics Review - from words to deeds ASSIST London & the South East 17 November 2008 Brian Derry brian.derry@ic.nhs.uk

2. Summary Background to the Health Informatics Review Health Informatics Review:  Strategy  Commitments Next steps and conclusions

3. Background to HIR Commissioned by NHS Chief Executive & DH Permanent Secretary in September 2007 Over 1,400 stakeholders consulted:  1,000+ frontline NHS staff  public opinion researched, through a deliberative event, online questionnaire and survey  voluntary organisations and professional bodies  SHA & NHS Chief Executive Officers and Chief Information Officers Findings published as part of NHS Next Stage Review, 10 July 2008

4. HIR scope To outline an information and IT architecture capable of supporting the world-class NHS envisaged in the NHS Next Stage Review Health Informatics Review Programme Project 3 Creating an information system and management structure Project 1 Meeting the information needs of the DH and NHS “Information” “NHS CRS and SUS” “Governance” Project 2 Maximising the benefits from NHS CRS & SUS

5. NHS Next Stage Review

6. High quality care for all: NHS Next Stage Review Quality at the heart of the NHS High quality care for patients and the public Freedom to focus on quality High quality care for all Raising standards Stronger involvement of clinicians in decision making at every level of the NHS Fostering a pioneering NHS Empowering frontline staff to lead change that improves quality for patients Valuing the work of NHS staff Help to stay healthy Empowering patients Most effective treatments for all Keeping patients as safe as possible

7. Success is getting from:…to: Patients Patient records held on paper, hard for the patient to access or understand Choice poorly understood and limited information available to support patients I have access to my record I understand what is going to happen to me and my options I can make informed choices to receive the best possible care I can be involved in my own care Public Disparate sources of information to inform the public about health and wellbeing with little control of validity Perception that NHS is not delivering value for money I know where to find trusted answers on health and wellness I can see how my local health services are performing I can see information about the quality of services provided Staff Variable access to up to date, timely and accurate clinical information causing errors and cancellations Management decisions often based on inaccurate operational and performance data, or no data at all Few systems to provide staff with access to targeted information to help them do their jobs or personalised information on their development and learning Single source of patient & clinical information available at the point of care Electronic records will reduce the burden, help to join-up treatment along care pathways, & lead to improved patient care Clinical performance indicators available for individuals, managers & organisations to improve patient care Staff have access to relevant information & an employment, knowledge & learning support system

8. Need for high quality information People want information to:  understand choices about care, & how to stay healthy  be confident that health & social care staff have the information needed to provide care effectively and safely Care professionals: when providing care, regardless of where the person was previously seen Commissioners: plan & redesign services Managers of health & social care services:  monitor & assure quality  make decisions based on evidence & best practice  account for their actions Regulators: to assure NHS & independent sector care providers

9. Strategic Implications

10. HIR key themes Delivering better, safer care: person-based information for clinical & care processes, shared across organisational boundaries Empowering staff to improve NHS performance: research, planning & management, improving quality of care & supporting regulatory activities Empowering patients and the public: -making information available about health, services, & patients’ own health & wellbeing -providing patients with secure access to their own electronic records & increasing their involvement in shaping the NHS Focusing on IT alone will not meet the needs of the NHS.

11. Strategic consequences Patient information available at the point of need Strategic solutions making patient/client information available securely across care settings People will be able to:  access their own care record securely  have information to make informed choices about their own healthcare and wellbeing Additional services available to patients on-line Information should:  be collected once, as a by-product of care  be used many times - new data only when absolutely necessary  be improved through an integrated data quality programme.

12. Clinical priorities Achieving the strategic vision: Investigate interim solutions & widening choice of LSP solutions Local solutions subject to convergence with LSP & national strategic direction, & to local funding & business cases Early delivery of priority secondary care products (“clinical five”): PAS integrated with other systems & with sophisticated reporting Order Communications and Diagnostics Reporting - all pathology & radiology tests, & tests ordered in primary care Letters with coding: discharge summaries, clinic and A&E letters Scheduling: beds, tests, theatres e-Prescribing, including ‘To Take Out’ (TTO) medicines Fill information gaps: clinical metrics mental health; community and social care.

13. HIR commitments 1.Information and Standards 2.Systems and Benefits 3.Informatics-literate NHS

14. 1. Information & Standards

15. Information Actions Filling gaps:  clinical metrics  Community  Mental health  Social care Streamlining data collections Data quality Access and use:  Syndication & Signposting  Strategic reporting solution

16. Clinical metrics Three broad workstreams: 1.Better use of existing data 2.Development of new measures 3.Patient Reported Outcome Measures (PROMS):  Four elective procedures mandated from April 2009  Data collected on day of admission and 3-6 months later  Data can be used by commissioners to hold providers to account and to contract on the basis of relative clinical quality as perceived by patients

17. PROMS ProcedureCondition-specificGeneric Primary Unilateral Hip Replacement Oxford Hip ScoreEQ5D Primary Unilateral Knee Replacement Oxford Knee ScoreEQ5D Groin Hernia RepairNoneEQ5D Varicose Vein ProceduresAberdeen Varicose Vein Questionnaire EQ5D Plus a standard set of patient-specific questions in all cases 5 dimensions: mobility, self-care, usual activities, pain/discomfort, & anxiety/depression.

18. Data Quality Programme DQ Lexicon Signposts to existing tools and good practice. Special interest groups and forums. DQ Accreditation Organisational DQ Standard framework. Self assessment tools. Formal audit. DQ monitoring. DQ Touchstone Comparator Quality Indicators Across datasets and collections. Linked to data catalogue. DQ Guild Stakeholders Organisation reps Informatics professionals Frontline DQ Awareness and education. Impact of data quality on patients, organisations and staff. Basic DQ guidance Stakeholders: Regulators: Healthcare Commission, Monitor, UK Statistics Authority, NAO, NICE Users: DH, Commissioners, SHAs, PCTs, researchers Data suppliers: SHAs, PCTs, NHS BSA, care providers Data quality mediators: Clinical Back Office, National Back Office, Local Back Offices, SHAs, PCTs System providers: CFH, LSPs, system suppliers Stakeholders: Regulators: Healthcare Commission, Monitor, UK Statistics Authority, NAO, NICE Users: DH, Commissioners, SHAs, PCTs, researchers Data suppliers: SHAs, PCTs, NHS BSA, care providers Data quality mediators: Clinical Back Office, National Back Office, Local Back Offices, SHAs, PCTs System providers: CFH, LSPs, system suppliers

19. Information Standards Fundamental review of (1970s) NHS data model to create one suitable for 21st century NHS Short- term improvements  meet immediate needs - community, mental health, private sector care & measures of clinical quality  reduce unnecessary bureaucracy Scope of the NHS Care Records Service to cover independent & voluntary sector providers, & social care Technology & standards to allow high quality local products to be integrated within hospitals; full integration of products across care settings & providers Robust process to ensure widespread adoption of existing standards (e.g. NHS number, SNOMED)

20. Data Standards Programme -7 elements 1.Logical Health Record Architecture  logical structure for an Electronic Health Record  definitions for key clinical concepts & associated coding 2.Commissioning Data Sets Futures – community, children & maternity, long term conditions 3.Streamlining the end-to-end standards process 4.Social Care 5.Pathways Groups – maternity, long term conditions… 6.Metrics for measuring Care Outcomes 7.Analysis and Currencies – outputs & units of care activity

21. 2. Systems and Benefits

22. Delivering better, safer care Quality at the heart of the NHS Empowering staff to improve NHS performance Freedom to focus on quality Empowering patients and the public High quality care for patients and the public Systems supporting high quality care NHS Care Records Service – Summary & detailed records Choose and Book PACS Electronic Prescription Service Secondary Uses Service Clinical Dashboards NHS Comparators Staff Gateway Research Capability Programme GP Extraction Service NHS Choices HealthSpace N3 Spine NHSMail

23. Clinical dashboards Clinical team, ‘day-to-day efficiency’ dashboard Monthly ‘quality of care benchmarking’ dashboard Individual, ‘comparative clinician’ dashboard Locally defined dashboards: improve patient flow & treatment patterns; multi-disciplinary. Rapid updates (up to every 15 mins) Locally defined dashboards: improve patient flow & treatment patterns; multi-disciplinary. Rapid updates (up to every 15 mins) Allows clinicians to monitor and benchmark process effectiveness & outcomes against best practice. Focus on qualitative outcomes, e.g. patient experience, quality of care. Weekly/monthly updates. Allows clinicians to monitor and benchmark process effectiveness & outcomes against best practice. Focus on qualitative outcomes, e.g. patient experience, quality of care. Weekly/monthly updates. Allows clinicians to monitor individual metrics, compared with peers. ’Portfolio’ contributes to continued accreditation with professional bodies. Weekly/monthly updates. Allows clinicians to monitor individual metrics, compared with peers. ’Portfolio’ contributes to continued accreditation with professional bodies. Weekly/monthly updates. Indicators align to national/international best practice & be integrated with national clinical protocols (e.g. designed by Royal Colleges)

24. Staff Gateway Support NHS staff in delivering first class quality of care through education & training, & access to knowledge & information NHS staff now have to access many different internal information & IT systems to do their jobs Staff Gateway to provide:  ‘one-stop-shop’ for the key information sources  Professional portfolio:  single access point to development and knowledge  a space for storing information essential to appraisal, revalidation & clinical excellence awards  online log of personal activity & outcomes

25. HealthSpace Empower patients & public Already lets patients record information on their own health; also:  record preferences  record self-administered drugs & health monitoring  let patients see their own Summary Care Record

26. NHS Choices Much more information - not just hospital care but also primary & community care To be the reliable source of information to help patients understand their illnesses & stay healthy In time, will include:  other services such as those provided by social care will be included.  new local and national clinical metrics and dashboards

27. 3. Informatics-literate NHS

28. Informatics-literate NHS Strong informatics governance Within DH & NHS Outside DH & NHS Investment assessment Standards governance Policy integration Informatics staff Other staff Sound leadership Good processes Skilled staff

29. Sound leadership New CIO for Health – Christine Connelly - Board level post reporting directly to the NHS CEO CIO for Health formal responsibility for professional leadership to the major informatics organisations inside and outside the Department of Health Expectation that SHA, trust and PCT boards include a “credible, capable CIO able to contribute fully to strategic leadership and Board decisions” National informatics leadership to:  develop the profession  co-ordinate the existing expertise  build the informatics capability of the general and management workforce

30. Skilled staff Health Service leadership to address  skills needed to deliver large scale IT-enabled change  development of the Informatics Profession Informatics content in core training & professional development for NHS clinicians and managers Local informatics leadership, prioritisation & delivery, with central support & resources Informatics career pathways Apprenticeship, graduate training & talent management schemes.

31. Priorities - informatics specialism Visible professional leadership - centrally & SHA CIOs Promote CIOs on NHS Boards - CIO for Health model Accreditation of informatics services, processes & people Initial focus on IT, IM & PPM Encourage registration with UKCHIP Subsidiarity - strong local focus for governance, prioritisation and delivery, supported nationally Access to additional skilled resources to support local implementations, e.g. central support teams, national call- off contract.

32. Good processes Improved arrangements for early assessment of the central and local informatics implications of new policy – “Policy and Business Informatics Support” Ensure that IM&T priority and funding is given to the most appropriate requirements Mainstream IM&T planning - NHS Operating Framework, IM&T planning guidance Develop accreditation of HI services – function of products, processes & people

33. Conclusions

34. Key messages - 1 Information and IT are central to:  improving health and social care services  empowering service users and staff Investment in IT allows a leap forwards in the scope, availability & use of information Emphasis on information about the quality of care, for patients, the public and staff Renewed focus on delivering systems now to meet clinical priorities

35. Key messages - 2 New CIO for Health:  reporting to NHS CEO  on NHS Management Board  underlines importance of informatics & provides a model for the NHS Recognition of the importance of informatics skills & new impetus to developing the informatics profession and workforce

36. Key messages - 3 NHS Connecting for Health:  Centre of IT expertise for NHS, not just NPfIT  Embrace private & voluntary healthcare providers, & Social Care Information Centre for health and social care:  Maximise the value of data collected  Encourage innovation in information & analysis markets  Source of data for DH, CQC and other official statistics.

37. HIR next steps Specific action plans – business cases, procurement, implementation etc Implementation by the autumn, aimed more at informatics specialists, with detailed update & plans Continued stakeholder engagement Embed as “business as usual”

38. Your questions?