Durham and DarlingtonICRS

Where to start?

Dr Grant Kelly

BMA Council

Chair, BMA ITC

Chair DoH EPB – now:

Privacy Enhancing Technologies Project

SEAG of GPRD

Chichester GP 21 years

Background 1

NWN 1994

“All patient data is to be accessible to the wider NHS family, and all those in contract with the NHS”

Background 2

“You have zero privacy anyway; Get over it.”

“Privacy is transient; it began following the demise of an all-seeing God and stopped when government, sensing a vacuum, stepped in to fill the gap”

Background 3

“Internet technology has evolved to support interaction between organisations with neither common aims nor management; as such it is ideally suited to the NHS”

Jonathon Kay

BMA/clinician view

We need to move forward

We appreciate the potential of electronics

Fully-functional, progressing e-NHS

We (variably) recognise the mountain (range) we have to climb

What’s the aim?

To replace paper by electronics for:SpeedEase of useAvailabilityReliabilityAdded valueAnd with a net gain

….tough

Paper

Needs no power

Available (?)

Universally understood/useable

Law, business of supply, etc

Standards in place

Public acceptance/handling

…but

But:

Illegible

Gets lost/de-structured

Available in one place only

Is passive

Not a learning/auditing medium

………..time to move on

Non-negotiables….

Availability

Ease of use

Minimise consultation damage/Heisenberg

Confidentiality

Integrity

Authenticity

Non-repudiation

ICT thoughts

An unlinked computer is a waste of space

Linking computers (can) save work

Linking computers (can) reduce errors

But

only by establishing identity/access control

and using EDI

What’s out there?

?

What we’d like……

DVLA

HA SS

Partners

GPs

Data Store

PH

Trusts

MH

EPR

MH Partners

GPsPH

TrustsSS

HA

Clinical teams and information

Patient-present needs

Patient-absent needs

Definitions for clinicians

Integrated…

Joined together

Federated

Conforming despite time & space

Appears to work as one to the user

‘Direct’ Care

The processes employed to improve a person’s lot when suffering from disease and its adnexae

Complex

Easily understood

Not so easily measured

‘Remote’ care

Planning

Information organisation

Booking

Referrals

Dispensing

Pathology etc.

Records 1

The abstracted knowledge about a person that enables efficient, accurate and appropriate care to be given to them

Records 2

DemographicsHistoryWishesDisasters/SuccessesWarnings ConsentConsent to publishetc

Service

Providing this to quality standards

Providing this to technical standards

The provision of derived added value

Hurdles

Who agrees the scope?

Scope creep

The different views

Procurement & testing (solutions)

Legacy staff & kit

Maintaining local apps

Integrity/Authenticity/Privacy/Consent

More than just a record