The new NHS information strategy urges health and social care services to make full use of online technologies to put patients in control of their health and health records.
The strategy puts a particular emphasis on the creation of portals for patients, health professionals, commissioners and researchers, in a series of moves that health secretary Andrew Lansley says will free up the "power" of information.
A national ‘portal’ will be created as the definitive source of trusted information on health and social care by 2013. The NHS portal will inform patients’ decisions on selecting treatments and providers.
This fits with the central theme of shifting to a presumption of sharing information within and between health and social care providers, and capturing data just once at the point of care.
"These proposals will ensure that the NHS will become easier to understand, easier to access and will drive up standards of care,” said Lansley.
A new commitment is given to make it far easier for the life sciences industry to access anonymised patient records, with the lead role to be provided by the Health and Social Care Information Centre.
An ambition is also outlined to develop integrated health and social care records, and provide patient access, “once technology permits."
The long-awaited strategy, developed after extensive consultation, is titled ‘The power of information of information: Putting us all in control of the health and care information we need.'
The strategy is big on ambition – nothing less than the previously promised 'information revolution' – but only offers a sketchy map of how to get there.
The first NHS information strategy since the multi-billion National Programme for IT in the NHS was launched a decade ago also almost entirely ignores its predecessor and the mixed legacy it has left.
Primary care information systems and national data collection are singled out for praise.
“Unlike previous information strategies, it does not reinvent large-scale information systems or detailed mechanisms for delivery," the foreward says. "Rather, it provides a framework and a route map to lead a transformation in the way information is collected and used."
A core guiding principle is that the centre should get out of the way except on core standards and undefined elements of national infrastructure.
The information strategy paints a broad big canvass, covering all health and social care organisations and defines information users as including clinicians, patients, carers, researchers and local councillors.
The strategy provides only hints of how these ambitions are to be achieved, with further “implementation papers” promised to follow.
No specific financial commitments are given, other than a brief statement that there will be some funding from capital investment for patients administration systems for hospitals that didn't receive them from NPfIT.
Cultural change is, however, identified as essential with recognition given to the need to invest on health informatics training.
Every organisation is directed to nominate a board-level chief clinical information lead, with recognition given to the potential of the new chief clinical information officer role.
The document says that as part of this transformation, information must become “regarded as a health and social care service in its own right." It says there is a need to catalyse a cultural shift in favour of information sharing and information enabled services.
“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 services.”
With the decision already taken to abolish the Department of Health Informatics Directorate, and the NHS Connecting for Health agency by next April, a key question will be who takes national responsibility for the delivery of the strategy.
In theory, this will be the NHS Commissioning Board in conjunction with Public Health England and the Health and Social Care Information Centre, but overall implementation responsibilities - including national standards development, accreditation, contracts procurement and management and the running of core national information services – are so far unclear.
© 2012 EHealth Media.
Transferring documents & images between primary & secondary careNeelam Dugar 161 weeks ago
This can be made really easy & simple in the NHS.
NHS needs to use XDR standard of IHE with standard metadata set. Ed Conley, Tim Benson & others have been working with IHE-UK, & CFH/ITK team so that a standard metadata set can be agreed for the UK.
What are the implications of this for existing systems?Mary Hawking 161 weeks ago
How would adopting new standards affect existing systems - particularly fully functioning GP systems?
As it is, the Impact Assesment - in the spreadsheet - shows CCGs paying for Patient Record Access - presumably that means development costs...
Time for existing systems to stop being so helpless and needyGuildfoss 161 weeks ago
This argument was the right stand to take against NPfIT, but completely the wrong one to take now. Existing Systems are now the bad boys - especially when they are a CLOSED PRIVATE CLUB funded by public money. Its time that these ever-needy suppliers took part in activities like the connectathon: cat2012.org/ and #nhshackday using their own funds (or should I say recycled public money)
Groan.eohl 161 weeks ago
So the information strategy view on the portal is getting the patient to see the records the GP holds?
I think what I would have liked to see is some sort of grading for information, using in part (old) priorities for communications systems (ignore the clinical examples, the are examples - not for an IT guy to set):
Z Flash - e.g. Allergies ASAP
O Immediate - Medication within 30 mins
P Priority - 3 hours Summary medical record - patient portals
R Routine - Discharges
And standards that say all NHS systems should offer Flash by 2013, Immediate by 2014, etc.... i.e. Get the interchange of information delivered by priority of need.
From Paul CurleyLyn from Digital Health 162 weeks ago
EHI has been gathering comment on the NHS information strategy from think-tanks, people working in the NHS, and system suppliers. You can see some of the results in the Insight section.
This arrived too late for the feature. But it's a thoughtful contribution from a consultant surveon and clinical director for IM&T, working at Mid Yorkshire Hospitals NHS Trust - which has also featured in our newspages this week.
"Publication of the IT strategy is delayed and much vaunted. The demise of Connecting for Health as a comprehensive operational strategy and organisation has the potential to see fragmentation of Healthcare IT across the NHS. Some of the principles in the strategy are welcome, much is a rehash of previous documents and the absence of detail is disappointing after such a long delay.
The provision of standards for data is a requirement - but disappointingly little has been achieved in secondary care over the last number of years. Picture Archiving and Communication Systems (PACS) have been one of the major successes of the NPfIT programme but even now the promised ability to view images acquired in one site at any other site is not live. This, despite the standard of DICOM being applied.
Undoubtedly primary care has come further faster. It is reality that a small number of providers of "GP systems of choice" dominate the market and in general these allow records to be transferred seamlessly to another GP if the patient moves practices. But what of secondary care ? A speaker from King's College Hospital London at HC2012 stated that their "mature" in-house EPR was very useful internally but when asked what happened when a patient moved to another part of the country, said that the record could not be transferred, exported or understood elsewhere. Is this the best we can do ?
Standards are of help. But what we really need is interested, knowledgeable and influential clinicians given the authority and power to effect change. This is where the EHI Chief Clinical Information Officer campaign was so visionary. We need the Clinical Leaders Network, the Department of Health, the Chief Medical Officer and the Medical Director of the NHS to work together to get clinicians to take responsibility for IT - particularly in secondary care. We need systems that allow transfer of data readily between providers, we need simple and secure ways of transferring results, investigations, letters and other electronic information to legitimate partners (GP, other Trusts, patient).
The emphasis on patient access to information is interesting. Unquestionably many patients will access and take ownership of their records. This is to welcomed. However, a significant proportion have little interest in handling their medical records. They want healthcare professionals to have access to, interact with and record within those records and to have the content readily available to the next professional in the care chain. Patients need to push for this seamless access - those who want direct access should be able to get it.
My overall impression is a document that is probably 100 pages too long. We need the DoH to set the direction. I believe the strategy has achieved this. We want government to push the NHS, Acute Trusts, GPs, industry and other stakeholders towards a vision of joined up healthcare information. We want government to be ruthless at identifying and reducing waste. Therein lies a potential problem. Without central oversight, many organisations are likely to develop their own way of solving what have been intractable problems. We do not want to have 170 acute Trusts with 60 different solutions - none of which readily receive or understand information sent from other Trusts. In short, we do not want multiple silos of information that are not connected.
King's EPR may work in King's, but what about the patient admitted elsewhere with their information locked in King's ?
The move away from a large cumbersome bureaucracy is welcome. But the network of Clinical Leads for IT within CfH is a loss. We need a well organised and respected group of clinicians ensuring that the problems and errors in their Trust are not left hidden from other Trusts. Let's redouble the campaign for CCIO posts. Let's ensure that those of us passionate about the NHS are engaged in maximising investment in IT for the benefit of the whole system. Let's solve the easy problems together."
Information is not locked in the King's EPRColinS 162 weeks ago
Getting a bit parochial here, but what Jack Barker was asked at the conference was whether the King's system was available to be accessed in other parts of the country. His response was No. This isn't actually totally accurate as it is accessible to our clinicians working in outreach clinics and to approved users in our Academic Health Sciences Centre. The information in our system is shared regularly and automatically with our local GP population in the form of letters over NHS mail and standard PMIP messages for Pathology and Radiology results.
I have always maintained that if standards could be agreed upon the opportunity to share what is necessary and appropriate from our system is one we would welcome, especially if it is a two way process. I still stand by this view and hope the strategy will progress that.
Local Safety more Important than National ConvenienceJack Barker 161 weeks ago
Always good to talk to you Colin.
The question I thought I was answering was: Can you easily transfer records in secondary care in the same way as I believe you can in primary care? As I understand it you can move from one primary care practice to another with the whole electronic record being transferred intact. Currently I don't think that can happen with information between secondary care providers.
In secondary care the information is probably much more complex and includes sophisticated imaging data-for instance. I don't think we are ready to move all this stuff around en bloc yet. We are already sending it electronically piecemeal to GP systems. We send radiology reports, blood test results, discharge summaries and clinic letters electronically.
The work of Prof Ian Carpenter and his team at the health Informatics unit of the Royal College of physicians should help bring some order to the internal structure of the documents and perhaps more extensive use of SNOMED coding will help with the other elements. These things are recognised in the new strategy.
I have no regrets about focusing on the internal workings of our hospital as opposed to making the information available easily should the patient want to move to another part of the country or should they become sick whilst visiting another part of the country. I think the bigger dangers lie within our hospitals. We need to make sure we spot when our patients are getting sicker, we need to support safe handover and we need to make hospitals more efficient and effective.
health informatics training?eohl 162 weeks ago
Is additional funding necessary? From what I've seen numerous resources are available but the need to use them isn't.
Again with global standards, quite an amount is already around,
aim for Level 2/3 CDA using SNOMED, don't introduce new kettering/pdf/tiff document exchange implementations.
When exchanging care plans stick to the SNOMED codes in NHS Care Planning for problem types and interventions, etc...
If your not exchanging data yet but plan to.... try where possible to use SNOMED codes i.e. don't use 01 for white british use 315236000
ICD 9/10 Read CTV3 is ok to use because you can map them to some extent to Concepts....
It's all on TRUD website http://www.uktcregistration.nss.cfh.nhs.uk/trud3/user/guest/group/0/home
Implementing SNOMED might seem simple but......Infoman 162 weeks ago
But consider the implications for all those down stream secondary data processes like SUS, PBR, clinical audit etc. Changing the data format for a single variable like ethnicity from "1" to "315236000" will either mean that the sending system (Trust PAS) has to translate the outbound data from "31523600" back to "1" or the recieving system (SuS) has to land "31523600" and then convert back to "1". If the data isn't mapped back then *every* local / national database, analysis and reporting system will have to be changed so that is can store and utilse the new code.
And of course even this simplistic mapping solution will impose significant costs on systems at a local and national level. The use of SNOMED for direct care purposes (clinical communication) is essential but one of key reasons SNOMED hasn't found traction in the NHS is that the business end of healthcare just can't see the cost benefit and all the reviews of SNOMED implementation have struggled with this problem.
Lobbying!Les Fawcett 162 weeks ago
Wow, EMIS have done some pretty impressive lobbying.
Their assumprtions are all over the financial Impact Assessment spreadsheet on the Strategy:
Lobbying?Mary Hawking 162 weeks ago
The Impact Analysis spreadsheet makes fascinating reading - really does!
In particular I love the source of evidence for massive savings in Patient Record Access from a study of 198 involved patients - and extrapolated to the total population of England.
I'm not sure where you see EMIS lobbying here: as only EMIS has developed Patient Record Access, it is inevitable that this will be mentioned and any figures for benefits would have to come from EMIS sites.
Desire for intraoperability is not confined to EMIS and INPS...
Cool document announced at the right time . . . JFGOWI . ..Guildfoss 162 weeks ago
For once the government have got it right. No sudden lurches in a different direction, an umbrella strategy of standards convergence which tells everyone to just get on with it!
There are two excellent open source case studies for people to follow and plenty of other exemplars.
I guess in an ideal world they would specify IHE as the open architecture that everyone should converge to, but hey, this is a good start - its now up to those people in the NHS who have big money problems so assess the options. . . or face the wrath of angry clinicians and patients!
Diluted nonsenseCharles Gallagher 162 weeks ago
A quote from the Information Strategy
"This strategy is deliberately and unashamedly aspirational. Because the benefits of improved information are so great, information must consistently be seen as being core to the business of health and care."
If this statement were true they should have published some tangible, aspirational, mandated targets to succeed.
As it is its just a piece of blue sky thinking that doesn't challenge the industry or the NHS one iota.
Green light, or just moss growing?JacquesOuze 162 weeks ago
Thanks Jon, your article is a masterpiece of restraint and objective, professional journalism. Not being a journalist, or even very professional, I can say that the Power of Information is the biggest pile of pants I've read in a long time - and believe me, I read some real merde.
It may be Mr Tickell's green light, but it's a green light to do nothing. Why should GPs extend patient record access? They have sbown little appetite for doing this so far, and now they're preoccupied with learning how to commission. Who is going to make them? Not the commissioning Board when it has bigger fish to fry. Similarly on standards and terminology - what levers or structures will there be to ensure their widespread adoption? Nothing here to answer that.
As you say, it's completely ignors the past and does not address which parts of the 'undefined elements of national infrastructure' will still be provided and by whom, or whether some of the known problems with that infrastructure will be addressed.
Of courese, additional clarity on these issues may come from the implementation papers, but the strategy iteslf appears less a 'framework and route map' and more a bucketload of whishy washy wishful thinking. No clarity, no structure, no teeth.
What did you really expect?personal opinion 162 weeks ago
Come now Monsieur Jacques, since when has any Government ever published a strategy that has anything definitive in it... apart perhaps from in Cloud-cuckooland (perhaps this is where you are from).
In the English speaking world we have a saying "every cloud has a silver lining". Parhaps where you come from it is the other way round... At least the strategy has now been published; and let's face it - it has been a long wait!
Seriously though, whilst I agree (in part) that there could have been more substance, it is far from the white-wash that many detractors predicted.
As always, we will have to wait for the dust to settle to see what effect it has on the industry.
Perhaps to learn from mistakes rather than repeat them?JacquesOuze 162 weeks ago
Maybe it's hope over experience, but still expect policy papers to be better than this. Personally, I put it down to the lack of a UK equivalent to Sciences Po and ENA. All those Oxbridge PPE types just can't cut it.
But it's not so much the general thrust of the document that's the problem, after all, it's really just the same old, same old - so it's difficult to figure out why it's taken so long to publish - it's the lack of any consideration of the strategic enablers that will make the difference between success (however limited), and yet another abject NHS IT policy failure. The overall message seems to be 'here are some nice to haves, please do it', and we all know how far that's likely to get us.
re: Green light, or just moss growing?mrtablet 162 weeks ago
I perhaps smelled less pants more mom and apple pie.
As Jacques says, this document studiously divorces policy from implementation. It thereby barely hints of delivery mechanisms, carrots or sticks.
I hope "The power of information" was delayed because solid implementation details were lagging behind which are now hot on it's heels.
If implementation papers do not follow quickly this will suffer the same fate as 2001's "Building the Information Core – Implementing the NHS Plan" : platitudes with which no reasonable person could possibly disagree - and totally ignored.
Back then everyone waited two years - only for NPfIT to turn up as the implementation plan!
So I'll keep the bunting furled for now.