On May 21, 2012, the UK Department of Health published The Power of Information which sets the direction for NHS information technology in England for the next ten years, post the National Programme for IT (NPfIT).
NPfIT represented a top-down, centrally-directed approach to healthcare IT. Its aim was to implement a national Summary Care Record (SCR, “the Spine”) with Care Records Systems (CRS) at every NHS Trust in England connected to and updating the Spine via a secure, national NHS network (N3). Contracts were awarded in 2003-4 to a small number of key suppliers.
The Information Strategy, by contrast, emphasises a reduced role for Central Government, allowing local NHS organisations more choice whilst opening up the NHS IT market to new entrants. It is “deliberately and unashamedly aspirational” and is not a detailed implementation plan, which will follow.
Although specifically a strategy for England, it has resonance globally, calling out significant areas where health IT – including big data, analytics, telemedicine, social media, portals, applications and online access to care records – can best support fundamental changes in health and care.
In this first of a planned series of blog posts, we will look at the NHS Information Strategy; it’s drivers, key themes and enablers. We invite you to share your thoughts, comments and questions with us.
The need for a new NHS Information Strategy has been driven by a number of factors, including:
- NHS Changes: including the introduction of self-governing Foundation Trusts and the 2012 Health and Social Care Act which radically restructures the NHS by reducing the number of health bodies, abolishing Primary Care Trusts and Strategic Health Authorities, increasing GPs’ powers to commission services and encouraging competition.
- Austerity and the QIPP Agenda: Following the challenge issued by NHS Chief Executive Sir David Nicholson to find £15-£20 billion in efficiency savings between 2011 and 2014 and the Public Account Committee’s report into NPfIT, there is a renewed emphasis on identifying cost savings from the innovative use of IT which may be redirected to front-line NHS services whilst improving the quality of care.
- Demographic and Epidemiological Changes: in particular an ageing population and the growing burden of chronic disease and long term conditions, require a different approach to delivering and integrating health and social care.
- Technology Changes: NPfIT contracts are now ending and the Programme’s structures are being dismantled. Although there have been some successes, the Programme will not be fully delivered. This has left significant gaps in the provision of healthcare IT, particularly in the Acute sector, and significant untapped potential to make better use of Virtual Era technologies such as: cloud, virtualisation, mobility, data analytics, social and web applications.
The Strategy has a number of interwoven themes, including:
- Local Choice: implementation, innovation, information sharing and IT systems procurement will all be locally-led, responding to local priorities and needs across health and social care.
- Individual Care Records: information will be recorded once, at first contact with care professionals and patients will be able to access their records online, starting with GP records by 2015 and social care records as soon as IT systems allow. Patients will be able to enter information into their care records, including self-assessed test results, feedback on treatment and demographic information. To make more effective use of SCR data, a review of the Spine will complete by October 2012.
- Online Access to GP Services: includes booking of GP appointments, ordering of repeat prescriptions and transmission of prescriptions by pharmacies using barcode labelled medicines, access to test results and communication with the practice.
- Online Access to Provider Services: includes extending the delivery of e-prescribing and improved medicines management to hospitals – using Automatic Identification and Data Capture (AIDC) – and to care homes, to reduce medication errors. Providers are to use structured, coded correspondence for referrals, discharge summaries, assessments, outcomes and letters and make existing shared and patient-held records, such as maternity and parents’ Red Book information, accessible online.
- Integration of Health and Social Care: changes to nationally collected social care data to ensure it is focused on outcomes will be implemented by 2013-14. This data will be linked with health data to improve understanding of the entire patient journey and all episodes of care. Local Authorities are to provide their clients with online access to assessment and care plan information as soon as IT systems allow.
- Telemedicine: to support self-care and home care, providers are to use mobility, applications and telemedicine as alternatives to face-to-face consultations.
- Big Data and Analytics: anonymised care record data will be combined and linked with other public service, care and clinical outcomes data and used to audit quality, benchmark and measure performance, guide commissioning, identify health trends and support the needs of research and life science.
- Social Media: Service improvement will also be driven by patient feedback. To make “each encounter count”, patient comments on their experiences will be actively sought. A Net Promoter Score (NPS)-like “friends and family” test will also be implemented in 2012-13. However, capturing, combining, analysing, responding to and acting on patient feedback from multiple, diverse channels will be complex, not least because the NHS provides over 1 million interactions every 36 hours and patient journeys of care cross a range of services.
- “No Decision About Me, Without Me”: opening up access to health information and services will fundamentally change the relationship between patients and care providers to one of shared decision-making.
A number of fundamental enablers are required to deliver the Strategy, including:
- National Information Standards: including minimum legal standards, which will be phased in over ten years, and the implementation of standard electronic formats including: pathology, diagnostic imaging, medicines, devices and clinical coding, allowing data returns in Systemized Nomenclature of Medicine-Clinical Terms (SNOMED-CT). To link all health and social care information about a patient, consistent use of the NHS number as the primary identifier will be adopted by 2015.
- Information Security: establishing an information security, identification and authentication infrastructure, for secure input, sharing, storage and access to health and social care information.
- Information Governance: an independent review led by Dame Fiona Caldicott on confidentiality and sharing of health and social care information will report later in 2012. Health and social care organisations will be required to adopt common information governance policies and standards, based on the NHS Information Governance Toolkit.
- Interoperability: the emphasis on local choice, delivery and implementation requires better integration between health IT systems and the adoption of open interface standards. Standards compliant EPRs, integration engines for data exchange, data warehousing to aggregate data and portals to present clinical data across specialities in one common view, will all assume greater significance.
- Organisational and Cultural Change: “the success of this strategy depends as much on a culture shift – in the way patients, users of services and professionals think, work and interact – as it does on data or IT systems”. The role of a Chief Clinical Information Officer (CCIO) will assume more significance as senior clinicians take a leading role in implementing the strategy, integrating health, care, informatics and IT.
- Funding: Central Government will no longer sign large national healthcare IT contracts; funding and responsibility for IT will increasingly become local. Assumed savings from NPfIT contracts, together with capital funds from the Department of Health will be available to fund implementation.
- Clear Responsibility for Implementation: Coordinating the large number of stakeholders to deliver the Information Strategy, whilst implementing the Health and Social Care Act, delivering £20bn in efficiency savings and the QIPP agenda will be challenging.
Dell and the NHS
To encourage the creation of a more dynamic and diverse health IT market, the Department of Health has partnered with Intellect – a UK technology industry body representing IT service companies including Dell – to provide IT industry input to the strategy and its implementation.
Dell supports the NHS Information Strategy and shares in the vision, as we believe better information drives better healthcare. Dell is ranked by Gartner as the number one worldwide healthcare IT services vendor and has partnered with the NHS to deliver healthcare solutions and services for over 15 years, including: clinical transformation consulting; clinical system deployment services, application services, infrastructure consulting services, medical records digitisation, mobile clinical computing and unified clinical archiving.