PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
RAISING THE ROOF
National Patient RecordsAnalysis Service
(NPRAS)
Gwyn ThomasNHS Information Authority
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
CHALLENGES TO HEALTHCARE
Growing Complexity- medical
- organisationa
l
Knowledge, Process and outcome management
Inconsistent Quality,
Confusion
Changing expectation
Patient-focused service
Dissatisfaction
Diverse, more efficient provision of care
Increasing demand
Insufficientcapacity
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
FUTURE PATIENTS*
• Better Informed• More personally accountable• Less uniform in attitude
and will expect …….
• Waiting within reason• Safe, effective equitable service• Hotel Services• An integrated, joined up system
*McKinsey 2002
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
EXPERIENCING HEALTHCARE
• Patient experience – Confidential journey along a care pathway
• Provider / user experience– Standard Tools to do their job
• Organisation experience– Effective & efficient management
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
• Health Provider – Where Care is given
• Health Network – Where Specific Care is Integrated
• Health System– Where Overall Integrity is Secured
Values
Clinical standards
Workforce / networks
Information
MAKING THE SYSTEM WORK – NATIONALLY
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
Providing National Information Services for the NHS
Supporting Local Communities
Implementing National Strategy
Supporting Health Networks
INTEGRATING THE HEALTHCARE SYSTEM– THE ROLE OF THE INFORMATION AUTHORITY
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
DELIVERING 21ST CENTURY IT VISION
support the delivery of care and services designed around each patient’s choice, quickly, conveniently and seamlessly
support staff through electronic communications, better knowledge management and support, faster access to essential information (notes, test results) and routine access to specialised expertise
improve the management of services by providing good quality data to support NSFs, clinical governance and management information
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
ICRS - Linking Up Health Communities
InformationGovernance
Analysis
InformationReporting
InformationCapture
UserEnvironment
User Tools
HealthCommunity
Pat
ho
log
y
Men
tal H
ealt
h
Acu
te C
are
So
cial
Car
e
Pri
mar
y /
Co
mm
un
ity Specific Functions
CHD
Older People
Mental Health
Diabetes
Cancer
NSFs
Service User IndexDiagnosis and Care
Booking and SchedulingOrdering & Reporting
PrescribingDigital Imaging
Knowledge Management
Generic Functions
AnalyticalServices
NHS DirectCAS
PopulationRecord
HRIReference
Files
Application Services
Nhs uk NeLHDecisionSupport
Information Services
Infrastructure Services
Network SecurityAccessControl
DirectoryE-maileStaff
RecordFinance
National Infrastructure
NHSINFORMATION AUTHORITY
“THE NATIONAL SERVICE PROVIDER”
THE NATIONAL
PROGRAMME
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
INFORMATION SERVICES OF THE NATIONAL HEALTH SYSTEM
Four Elements
• CONTEXT – Health Services Providers– common descriptions and details of services and providers
within the health system, their configurations and locations
• INTENT – Standards for Health Services– Using clinical knowledge and adopting standards of care across
the health system e.g. National electronic Library for Health
• ACTIONS – Personal Health Management– electronic records, e-bookings, referrals, investigations, and
prescriptions
• OUTCOMES – Measuring Performance of Health Services– consistent support of the clinical audit of individual care
Where can I go?
What will they (we) do?
What did they (we) decide?
Did it do any good?
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
NATIONAL INFORMATION SERVICES – REALISATION (1)
1. Health Service
Providers
3. Performance
of health services
2. Personal health
management
4. Standards for health services
National Health System Interface
NHAIS
NeLH NHS directory
NSTS
NWCS
nhs.uk
HRI
Where can I go?
What will they do?
What did they decide?
Did it do any good?
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
PAT & OSCAR
CLIN. GOV. TOOLKIT
ELDERLY CARE NSF TOOLKIT
HEALTHCHECK TOOLKIT
MENTAL HEALTH
CAPACITY PLANNING
PRIMIS
NWCS REPROCUREMENT
NCASP
CCAD
NATIONALPATIENT
RECORDSANALYSISSERVICE
MIGRATION
NATIONAL INFORMATION SERVICES – REALISATION (2)
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
NATIONAL CLEARING SYSTEM
NATIONAL PATIENT RECORD ANALYSIS SERVICE
CHANGING PRACTICEEDUCATION & TRAINING
LOCAL CARE RECORD SYSTEMS
WEB BASED ANALYTICAL TOOLKITS
NATIONAL ANALYTICAL SERVICES
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
NATIONAL PATIENT RECORD ANALYSIS SERVICE – Potential benefits
• Easier access to nationally consistent analyses on patient activity
• Greater sharing of information to allow comparative analysis
• More cohesive views of patients receiving healthcare services wherever it occurs
• Capability to undertake key national analyses once only• Improved availability of aggregated patient activity
across the whole healthcare system• Improved record linkage for audit across the whole care
pathway• Opportunity to provide a coherent framework for existing
disparate systems
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
ICRS Local / National – Patient RecordAnalysis Services
• Identifiable records for Individual persons• Immediate access• Dynamic, up to date
• Frequent abstracts• Focus on classes of persons • Time series• Short time intervals• Prospective indic- ators
• Focus on classes of patients• Actual compared with expected (inputs, outcomes)• Ongoing• Indicators
• Focus on classes of patients• Service and pop. based • Forecasting• Periodic
Operational /Direct Care
Audit / Performance review
Tactical Strategic /Planning
Examples of characteristics of requirements
Business Requirements
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
Demand management within local health systems• Emergency (e.g. winter pressures)• Elective
PCTsTrustsProvider partners (LA SS etc.)
Surveillance• Incidence of “adverse events”• Incidence of communicable diseases
PCTsTrustsNPSA CHI?PHLS
Resource deployment and allocation• Across care teams and service areas
PCTs,TrustsProvider Partners
Operational /Direct Care
Audit / Performance review
Tactical Strategic /Planning
Business Requirements
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
Audit of clinical / care services• Quality• Effectiveness and outcomes• Risk management
NHS wide – CHI > CHAIClinical / care networks and partnershipsIndividual organisationsClinical / care teams
Service performance improvement, monitoring and review
• Monitor and review achievement of national and local objectives and targets for access, effective-ness, outcomes, efficiency and quality
• Early identification of performance problems
• Development of responses and plans
StHAsClinical / care networks and partnershipsPCTs Trusts
Commissioning• Development and monitoring of SLAs
PCTsTrusts, Commissioning partners
Operational /Direct Care
Audit / Performance review
Tactical Strategic /Planning
Business Requirements
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
Service Planning• Population based needs assessment• Capacity planning, service reviews• Planning and development of networks• Health contribution to overall regeneration planning • Development of LDPs
NHS Wide GroupsStHAs and clusters of PCTs, Trusts and partnersLocal care communities – strategic partnerships
Surveillance• Prevalence and incidence of diseases and problems
NHS wideRegionalLocal communities
Strategic resource allocation• Across populations
DoHPCTs
Research• Public health / epidemiology• Medical (e.g. treatment / care outcomes)
NHS Wide / LocalNHS OrganisationsAcademic researchers
Operational /Direct Care
Audit / Performance review
Tactical Strategic /Planning
Business Requirements
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
NPRAS Characteristics and Objectives
• Characteristics of the Service– Comprehensive– Responsive– Easily accessible– Cost effective and
value for money– Secure– Accurate– Timely– Relevant and fit for
purpose– Flexible
• Investment Objectives– Improve user access to data
to meet business needs– Secure consistency in data
available– Improve coverage and
quality of data– Improve security of data– Prevent duplicate
abstraction– Enable greater public
involvement in decision making
– Enable users to improve services
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
•Mapping & reference services•Data management•Access through consistent user interface•Aggregated data•Data extracts for indicator construction•Extended data to include aggregate & population data
•Standard analysis & reporting•Analysis tools & models
NPRASPreferred Option
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
NPRAS – Trials
• Understand the practical implementation issues of using electronic records for secondary analysis
• Sharing models & options for delivering NPRAS type functionality using electronic records as the data source
• Demonstrate how to link local records systems with national systems (e.g. NWCS) for analytical information
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
NPRAS – Trials• Bradford -
– consolidation of disparate GP systems – analysis of primary care data
• Cornwall - – community wide management & clinical analysis – developing electronic links for data analysis (Cornwall
wide & national flows)
• Dorset - consolidating PCT & GP systems for – clinical governance (CHD) – management information (prescribing vs dispensing)
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
NPRAS – Trials• Hampshire & IoW -
– analytical information from various hospital based systems, NHS Direct, Ambulance, Social Services to support clinical governance
• Walsall - – supporting NSFs and clinical governance using
primary and secondary care data
• Wirral -– using Trust systems and electronic records across
hospital systems for analysis
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
Key messages from NPRAS Trials
• Issues needing to be resolved at national level– National information standards which are enforced– Pseudonymisation protocols– Information sharing protocols with non-NHS
organisations– Primary Care ‘Dataset’ based upon new GP contract– ‘Push’ model is more effective & efficient than ‘pull’
for a service as complex as healthcare analysis– Provide for accredited analytical software tools or
procure single supplier for analytical software tools– Rationalise & ensure consistent core requirements
across NSFs
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
• Issues needing to be resolved at local level– clinician involvement & buy-in– data quality & integrity to develop ‘trusted’
information– continual training & education for local staff
(users/data suppliers)– adherence to national standards even if different
from current practice– active use of the information to support
decision-making processes– investment in systems and people
Key messages from NPRAS Trials
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
• Other issues needing to be resolved– Relationship between local analytical services
(systems & people) & NPRAS– Ensuring that funding is available to support local
requirements to use NPRAS as well as national level funding
– Being clear about the relationship between current systems/services with similar functionality with NPRAS (e.g. OSCAR, NCASP, Dr Foster), and identifying migration & implementation timetables
– Start with data that already exists, link it, use it and improve it
Key messages from NPRAS Trials
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
NATIONAL CLEARING SYSTEMNWCS – ‘Mk 2’
Current Assets& ICRSLOCAL CARE RECORD SYSTEMS
NATIONAL ANALYTICAL SERVICESNHSIA
WEB BASED ANALYTICAL TOOLKITS NHSIA/SUPPLIERPARTNERSHIPS
CHANGING PRACTICE
EDUCATION & TRAINING NHSIA/NHSPARTNERSHIPS
MAKING IT HAPPEN …
PRIMIS Third National Conference Tuesday 1 April 2003Birmingham
RAISING THE ROOF
National Patient RecordsAnalysis Service
(NPRAS)
Gwyn ThomasNHS Information Authority
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