data communications between the nhs and independent sector clinicians in england
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Data Communications between the NHS and Independent Sector Clinicians in England
Prof. Ricky Richardson
BSc MBBS MRCP(UK) FRCP FRCPCH DCH DTM&H
Consultant Paediatrician
Visiting Professor of eHealth - Imperial College
Director of Global eHealth Ambassadors Programme
Chair, Independent Doctors Federation IT Committee
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The Problem
Hospitals
Primary careTertiary Care
Labs
Home Care
Registries
Clinics
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Independent Doctors Federation
•Formed in 1989 as a Forum, became the Federation in 2009
•Represents independent doctors in all matters relating to private medicine,
education, appraisal and revalidation.
•Currently 1000+ members
– 67% Consultants, 33% GPs
– 43 corporate sponsors
•Supports excellence in independent medical practice
•Seeks to influence Government and regulators in all aspects of independent
medical practice.
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IDF IT Committee
IDF IT Committee was reconvened in 2009 and asked to establish:
1. What IT systems are currently being utilised by practitioners and small specialist clinics within the independent sector
2. Which IT systems are being utilised by the current major independent sector providers.
3. Develop active links between Independent Sector and the Department of Health to define a process for patient data held under the NHS to be more readily available to the independent sector, and vice versa
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IDF IT CommitteeProf Ricky Richardson (Chair) Consultant Paediatrician
Dr Ralph Abraham Consultant in Diabetes and Endocrinology, London Medical
John Coulthard Director of Healthcare and Life Sciences, Microsoft UK
Stephen Gatley CEO, Sybermedica
Michael Gogola Director of IT&S, HCA International Limited
Rachael Granger IT Manager, The London Clinic
James Greenman Chair Independent Sector IT Council, Group IT Director, Care UK
Prof Richard Kitney OBE Professor of Biomedical Systems Engineering, Imperial College
Mark Large IT Director, Great Ormond Street Hospital for Children
Brian Painting NHS Business Manager, Microsoft UK
Mike Roberts IT Director, The London Clinic
Sally Taber Director, Independent Healthcare Advisory Services (IHAS)
Mark Treleaven First Databank Europe Ltd, representing Intellect
Harvey White Consultant Surgeon, representing the Royal Society of Medicine6
Research & Analysis
•Survey of IDF members
•Online questionnaire, 80+ responses
•Additional discussions with:
– Independent Providers & Practitioners
– System Suppliers
– Defence Medical Services
– Great Ormond St Hospital for Children NHS Foundation Trust
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Research & Analysis
•72% use software to manage practice
Practice Manager (DGL Solutions); 20.00%Midex Pro
(Avebury Com-puting Ltd);
15.00%
Crosscare (Healthy Software Ltd); 11.00%
Other; 26.00%
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Research & Analysis
•23% use custom or no software to manage practice
Custom-built / Self-written
Software 10%
Don't Use software
13%
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Research & Analysis
•92.5% of respondents exchange patient information with NHS using a variety of means
10 Some survey respondents used more than 1 method
Research & Analysis
•The vast majority of independent doctors have no means of exchanging data electronically with the NHS
•Only 5.7% claim to have some form of network connection
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Research & Analysis
83.6% of respondents did not know if their practice management system complied with current NHS requirements for secure data transfer.
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Research & Analysis
•The impact on patient care arising from an inability to exchange patient information
Risk of inappropriate treatment
Difficulty in discussing cases with colleagues
Risk of incorrect diagnosis
Delayed treatment
0% 10% 20% 30% 40% 50% 60% 70%12
Source: Survey of IDF Members
Report Conclusions
•Serious lack of integration between NHS and Independent Sector IT systems
•Absence of a clear NHS strategy for systems that permit data sharing
•Need for co-operation between state and private sector organisations to create a cost effective mechanism for clinical data exchange
– between "qualified providers" notably those with smaller practices
•Potential benefits for a move towards a culture of shared ownership of data (and risk) between clinicians and patients
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Recommendations
1. Engage with DH to:
•Facilitate access by Independent Doctors to the NHS National Network
•Work to agree common standards for the exchange of patient data with NHS systems
•Help raise awareness of confidentiality and security requirements affecting patient information and data transfer
•Encourage adoption of electronic practice and clinical management systems by the Independent Sector
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Recommendations
2. Set up a Clinical Expert Working Group:
•To study information pathways in various patient constituencies with similar issues and barriers
• Illustrate practical problems and viable solutions
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Next Steps
•Produce evidence through case studies:
– Care for Service Personnel
– Care for Paediatrics/Children
– Care for the Elderly
– Care for Offenders
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Care of Service Personnel
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Casualty Analysis & Reporting
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A Personal Experience
“We were all issued with morphine. You self-administer that the moment you're injured. There was a good chance you'd arrive at Camp Bastion conscious but delirious. And certainly bewildered and shocked.
You'd quite possibly then be sedated and not wake up until you arrived in Selly Oak in Birmingham”.
David Cotterell, Artist
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Patient Journey Overview
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Casualty
Field Casualty Stabilisation
Transfer to Camp Bastion, Helmand, Afghanistan
Airlift transfer to UK hospital
Rehabilitation
British Casualty Rates - Afghanistan
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British Casualty Figures in Afghanistan1 January 2006 to 28 February 2013 (Source: www.gov.uk)
Killed
Wounded In Action
Disease or Non-battle Injuries
Seriously / Very Seriously Injured excluding disease
Aeromedical Evacuations; UK military & civilian
0 1000 2000 3000 4000 5000 6000 7000
440
2096
4468
590
6568
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Issues
• Inpatient care when necessary is provided by the NHS, contracted by the MoD
•Longer term mental health care contracted to independent sector
• Issues faced by the Defence Medical Services in dealing with the NHS:
– lack of standards to provide a common language for communications between systems
– inconsistencies in process, e.g. payments for cases
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Care of Paediatrics/Sick Children
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Care of Elderly
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Care of Offenders
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Case Study Objectives
•Review all activities that contribute to the treatment and pathways of care in the immediate and long term
• Identify the information flows required at each stage of treatment along the pathways of care
• Identify and understand all existing or potential barriers which prevent the timely or efficient transfer of patient information in any format between practitioners at each stage
•Comment and draw conclusions on the findings of the study
•Suggest appropriate modifications to current practice and make recommendations for their implementation (in areas which might include process, system interoperability, information governance and information management)
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Independent Expert Working Group
•Part of Imperial College iHealth initiative
•Chaired by Prof Dick Kitney, Professor of Biomedical Systems Engineering
•To include IDF and other contributing partners
• Issues are wider than original remit
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Patient-held Records Policy
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No Barriers – Less Risk
Clinics
Hospitals
Primary careTertiary Care
Labs
Home Care
Registries
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In Summary
•No policy on sharing patient data between systems
•Freeing-up commissioning is valid but patient safety is compromised because systems don’t talk
•Current IT systems use proprietary not open architectures
•Moving to a patient-held record environment with patient-specific apps.
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Learning To Share
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