Woodcote Consulting

IT in Health?IT in Health?

BCS North London BranchBCS North London Branch

March 2006March 2006

Woodcote Consulting

Ewan DavisEwan Davis

Chairman - BCS Primary HealthCare GroupChairman - BCS Primary HealthCare Groupwww.phcsg.orgwww.phcsg.org

Vice Chairman – Intellect Healthcare GroupVice Chairman – Intellect Healthcare Groupwww.intellectuk.orgwww.intellectuk.org

Director - Woodcote Consulting LtdDirector - Woodcote Consulting Ltdwww.woodcote-consulting.comwww.woodcote-consulting.com

ewan@woodcote-consulting.comewan@woodcote-consulting.com

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An Apology – TLAs and FADAn Apology – TLAs and FAD

• FAD = Fatal Acronym Density. The FAD = Fatal Acronym Density. The point at which the number of point at which the number of acronyms in a document or acronyms in a document or presentation reaches the level at presentation reaches the level at which the document or presentation which the document or presentation is no longer capable of conveying is no longer capable of conveying meaning meaning

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BackgroundBackground

• Changing demographicsChanging demographics

– Aging population increasing numbers needing Aging population increasing numbers needing care while reduce numbers available to deliver care while reduce numbers available to deliver and pay for itand pay for it

• Increasingly capable medical technologiesIncreasingly capable medical technologies

• MedicinesMedicines

• GenomicsGenomics

• Medical devicesMedical devices

• New techniques and proceduresNew techniques and procedures

• Greater citizen expectationsGreater citizen expectations

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UK National Health ServiceUK National Health Service

• Universal provision substantially free Universal provision substantially free at the point of useat the point of use

• Recent historyRecent history

– Middle ranking quality both in terms of Middle ranking quality both in terms of outcomes and serviceoutcomes and service

– Low costLow cost

– Good value for moneyGood value for money(compared to other developed countries)(compared to other developed countries)

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UK NHS …UK NHS …• Substantial new investment lifting expenditure Substantial new investment lifting expenditure

towards European mean (from 7% to 10% of GDP)towards European mean (from 7% to 10% of GDP)

– £56 Bn 2003£56 Bn 2003

– £90 Bn 2008£90 Bn 2008

– £100 Bn 2012 ?£100 Bn 2012 ?(i.e double the cash in 10 years)(i.e double the cash in 10 years)

• Where has the cash goneWhere has the cash gone

– More facilitiesMore facilities

– More staffMore staff

– Better pay (including a significant unplanned and Better pay (including a significant unplanned and unjustifiable element)unjustifiable element)

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What is the NHSWhat is the NHS

• Not a corporate bodyNot a corporate body• Consisting of:Consisting of:

– 900 legal entities (Trusts, Health Authorities, Others)900 legal entities (Trusts, Health Authorities, Others)

– 40,000 independent contracts (GP practices, pharmacies, 40,000 independent contracts (GP practices, pharmacies, dental surgeries, opticians shops)dental surgeries, opticians shops)

– 1.3 million employees the (worlds 31.3 million employees the (worlds 3rdrd largest) largest)

– An unknown number of partners and suppliers working An unknown number of partners and suppliers working primarily for the NHS primarily for the NHS

• Works closely with many other governmental , commercial Works closely with many other governmental , commercial and independent sector organisation in social care, and independent sector organisation in social care, education, criminal justice, healthcare provision, supplies education, criminal justice, healthcare provision, supplies and research.and research.

• No clear boundary No clear boundary • Maybe a federationMaybe a federation• Probably more like a supply chainProbably more like a supply chain

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UK NHS …UK NHS …

• What’s been deliveredWhat’s been delivered

– Some improvements in outcomes and Some improvements in outcomes and serviceservice

– Some necessary infrastructure Some necessary infrastructure improvements and service improvements and service reconfigurationreconfiguration

– Not enough (yet?)Not enough (yet?)

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Policy ApproachPolicy Approach

• Stick with NHS founding principles – Free at Stick with NHS founding principles – Free at point of use – Funded out of general point of use – Funded out of general taxationtaxation

• Increase expenditure towards European Increase expenditure towards European meanmean

• Seek radical workforce and service Seek radical workforce and service modernisationmodernisation

• Complete the purchaser provider split and Complete the purchaser provider split and encourage more NHS provision by non-NHS encourage more NHS provision by non-NHS bodiesbodies

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Policy ElementsPolicy Elements• Choice, competition and contestabilityChoice, competition and contestability

– Practice based commissioning, payment by results, direct Practice based commissioning, payment by results, direct payments - Money follows patientspayments - Money follows patients

– Greater involvement of the independent sectorGreater involvement of the independent sector

– Greater autonomy for NHS organisationsGreater autonomy for NHS organisations• Care closer to patientsCare closer to patients

– More services in primary careMore services in primary care

– New providers outside hospitalsNew providers outside hospitals

– Assistive technologiesAssistive technologies• Workforce modernisation Workforce modernisation

– Breaking down professional dividesBreaking down professional divides

– Making better use of available skillsMaking better use of available skills

– New classes of healthcare workersNew classes of healthcare workers

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Policy Elements …Policy Elements …

• Preventative medicine and Managed carePreventative medicine and Managed care

– Keeping people healthy Keeping people healthy

– Keeping the chronically ill stable and productiveKeeping the chronically ill stable and productive

– Avoiding crisis interventionsAvoiding crisis interventions• Better integration between health and social care Better integration between health and social care • Risk ManagementRisk Management

– Patient SafetyPatient Safety

– Negligence litigation Negligence litigation • Patient self-care Patient self-care

– Patient access to records and informationPatient access to records and information

– The expert patientThe expert patient

– Support for carersSupport for carers

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The Common Theme?The Common Theme?

• A new IT Infrastructure to share A new IT Infrastructure to share knowledge, patient records, and knowledge, patient records, and workflows across the health care workflows across the health care supply chain.supply chain.

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The CommitmentThe Commitment

• To provide the NHS with the IT it needs To provide the NHS with the IT it needs to transform the way healthcare is to transform the way healthcare is delivereddelivered

• To raise NHS IT spend to 4% of NHS To raise NHS IT spend to 4% of NHS revenue by 2008 (from a base of 1.7%)revenue by 2008 (from a base of 1.7%)

• Equates to £30 bn over the 10 years of Equates to £30 bn over the 10 years of the NPfITthe NPfIT

• £6.3 bn allocated to the NPfIT in £6.3 bn allocated to the NPfIT in England. The biggest ever civil IT England. The biggest ever civil IT programme in the worldprogramme in the world

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The NPfIT VisionThe NPfIT Vision• To provide To provide securesecure, , appropriateappropriate and and timelytimely access to all access to all

those concerned with the delivery of care to an individual to those concerned with the delivery of care to an individual to relevantrelevant parts of that individuals care records parts of that individuals care records where and where and whenwhen needed to ensure needed to ensure good qualitygood quality and and efficientefficient care care delivered in a delivered in a Medico-legally robust Medico-legally robust manner.manner.

• To provide workflow management and decision support To provide workflow management and decision support tools to support the patient’s journey along the tools to support the patient’s journey along the mostmost appropriateappropriate clinical pathwayclinical pathway within and across within and across organisational boundaries in a way that delivers organisational boundaries in a way that delivers quality quality carecare;; convenient serviceconvenient service and makes the best use of NHS and makes the best use of NHS resources.resources.

• To provide patients and carers with To provide patients and carers with appropriateappropriate access to access to the the information and knowledge they needinformation and knowledge they need to play an active to play an active role in their own care or that of the person they care for.role in their own care or that of the person they care for.

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The PlanThe Plan• Provide enterprise wide EHR systems Provide enterprise wide EHR systems

covering regional health economies covering regional health economies linked to a national spine and national linked to a national spine and national services.services.

• National services to includeNational services to include

– A new National Network (N3)A new National Network (N3)

– A National Care Record ServiceA National Care Record Service

– Electronic Booking - Choose & BookElectronic Booking - Choose & Book

– An Electronic Prescribing Service An Electronic Prescribing Service

– A Secondary Uses Service (Data warehouse)A Secondary Uses Service (Data warehouse)

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N3N3

• To replace the existing NHSnet with a To replace the existing NHSnet with a broadband servicebroadband service

• To support the national servicesTo support the national services

• To support NHS the Intranet (nww) To support NHS the Intranet (nww) and NHS email service (Connect)and NHS email service (Connect)

• To provide the NHS with Internet To provide the NHS with Internet accessaccess

• To provide WAN connections To provide WAN connections between NHS sitesbetween NHS sites

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National Care Record National Care Record ServiceService• A national spine providing:A national spine providing:

– Patient demographics (PDS) Patient demographics (PDS)

– Summary EPR (PSIS) Summary EPR (PSIS)

– Security services (SoS, RBAC, LRs)Security services (SoS, RBAC, LRs)

– Transaction brokerage service for other national Transaction brokerage service for other national servicesservices

• An integrated, shared patient record across An integrated, shared patient record across local (regional) health economieslocal (regional) health economies

• A patient portal (www.myhealthspace.nhs.uk)A patient portal (www.myhealthspace.nhs.uk)

• A feed of pseudo-anonymised data to the SUSA feed of pseudo-anonymised data to the SUS

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Choose and BookChoose and Book

• To support the creation of a fully To support the creation of a fully bookable NHSbookable NHS

• To support electronic referrals by GPsTo support electronic referrals by GPs

• To support patient choiceTo support patient choice

• Eventually to enable patients to book Eventually to enable patients to book electronically in to front line services electronically in to front line services (GP practices etc)(GP practices etc)

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Electronic Prescription Electronic Prescription ServiceService• Enabling prescription to flow Enabling prescription to flow

electronically from primary care electronically from primary care prescribers to pharmacies and the prescribers to pharmacies and the reimbursement agencyreimbursement agency

– To enhance safety To enhance safety

– To improve convenience and efficiency To improve convenience and efficiency (particularly in relation to repeat (particularly in relation to repeat prescribing and repeat dispensing)prescribing and repeat dispensing)

– To populate prescribing records on PSISTo populate prescribing records on PSIS

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Secondary Uses ServiceSecondary Uses Service

• To create a data warehouse of To create a data warehouse of pseudo-anonymised NHS data for pseudo-anonymised NHS data for management and research proposesmanagement and research proposes

• Eventually drawing its data from the Eventually drawing its data from the NCRS but initially absorbing legacy NCRS but initially absorbing legacy systems (NWCS, HES)systems (NWCS, HES)

• Initial priority is to support Payment Initial priority is to support Payment by Resultsby Results

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Progress to DateProgress to Date

• N3 well establishedN3 well established• QMAS added to national services and QMAS added to national services and

100% rolled out100% rolled out• Initial implementation of EPS and C&B in Initial implementation of EPS and C&B in

placeplace• Single system approach abandoned in the Single system approach abandoned in the

south and diluted in the northsouth and diluted in the north• GP system choice confirmedGP system choice confirmed

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Progress to Date ….Progress to Date ….

• NCRS focus now on national summary NCRS focus now on national summary record, but not implemented yet.record, but not implemented yet.

• Little impact on acute EPR provisionLittle impact on acute EPR provision• Provision of PACS systems added and Provision of PACS systems added and

rolling outrolling out• National email service added and rolling National email service added and rolling

outout• GP2GP record transfer service added and GP2GP record transfer service added and

in pilotin pilot• SUS absorbing pre-existing services but no SUS absorbing pre-existing services but no

feed from NCRS yetfeed from NCRS yet

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Future DirectionFuture Direction

• Further redefinition and refocusing of Further redefinition and refocusing of CfH aims and objectives likelyCfH aims and objectives likely

• Likely continuing shift from Likely continuing shift from homogeneous to heterogeneous homogeneous to heterogeneous model. Enterprise system to model. Enterprise system to Enterprise Architecture (SOA)Enterprise Architecture (SOA)

• Slow progress to NCRS with greater Slow progress to NCRS with greater focus in integration of existing focus in integration of existing systemssystems

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IssuesIssues• Are the issues in the health care domain Are the issues in the health care domain

unusually complex?unusually complex?• Is the NPfIT trying to solve the right Is the NPfIT trying to solve the right

problem?problem?• Are either the right problem or the one that Are either the right problem or the one that

the NPfIT is trying to solve solvable?the NPfIT is trying to solve solvable?• How will issues of patient consent and How will issues of patient consent and

confidentiality be resolved?confidentiality be resolved?• How do you effectively combine world class How do you effectively combine world class

IT skills with healthcare domain expertise?IT skills with healthcare domain expertise?• Will the Government deliver on its 4% Will the Government deliver on its 4%

commitmentcommitment

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Some Parting FactsSome Parting Facts

• Over a million critical process occur in the NHS Over a million critical process occur in the NHS every dayevery day

• 50-75% of healthcare cost are incurred in the last 50-75% of healthcare cost are incurred in the last year of life (99% in the last 10 minutes if you are year of life (99% in the last 10 minutes if you are lucky)lucky)

• 10% of hospital admissions result from deliberate 10% of hospital admissions result from deliberate self-harmself-harm

• 10% of patients treated will be seriously 10% of patients treated will be seriously unintentionally harmed by the NHS. This leads to unintentionally harmed by the NHS. This leads to suffering, disability and death and costs the NHS suffering, disability and death and costs the NHS 2bn pa in extra hospital costs. Negligence claims 2bn pa in extra hospital costs. Negligence claims settled in 2003/4 cost £423 m with a total provision settled in 2003/4 cost £423 m with a total provision for outstanding claims in excess of £2 bnfor outstanding claims in excess of £2 bn

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More InformationMore Information

• www.nhscfh.nhs.ukwww.nhscfh.nhs.uk

• www.capitalcarealliancewww.capitalcarealliance

• www.bcswww.bcs

• www.phcsg.orgwww.phcsg.org

• www.intellectuk.orgwww.intellectuk.org

Woodcote Consulting

Ewan DavisEwan Davis

Chairman - BCS Primary HealthCare GroupChairman - BCS Primary HealthCare Groupwww.phcsg.orgwww.phcsg.org

Vice Chairman – Intellect Healthcare GroupVice Chairman – Intellect Healthcare Groupwww.intellectuk.orgwww.intellectuk.org

Director - Woodcote Consulting LtdDirector - Woodcote Consulting Ltdwww.woodcote-consulting.comwww.woodcote-consulting.com

ewan@woodcote-consulting.comewan@woodcote-consulting.com