Woodcote Consulting IT in Health? IT in Health? BCS North London Branch March 2006

Woodcote Consulting Ewan Davis Chairman - BCS Primary HealthCare Group Vice Chairman – Intellect Healthcare Group Director - Woodcote Consulting Ltd

Woodcote Consulting An Apology – TLAs and FAD FAD = Fatal Acronym Density. The point at which the number of acronyms in a document or presentation reaches the level at which the document or presentation is no longer capable of conveying meaning FAD = Fatal Acronym Density. The point at which the number of acronyms in a document or presentation reaches the level at which the document or presentation is no longer capable of conveying meaning

Woodcote Consulting Background Changing demographics Changing demographics –Aging population increasing numbers needing care while reduce numbers available to deliver and pay for it Increasingly capable medical technologies Increasingly capable medical technologies Medicines Medicines Genomics Genomics Medical devices Medical devices New techniques and procedures New techniques and procedures Greater citizen expectations Greater citizen expectations

Woodcote Consulting UK National Health Service Universal provision substantially free at the point of use Universal provision substantially free at the point of use Recent history Recent history –Middle ranking quality both in terms of outcomes and service –Low cost –Good value for money (compared to other developed countries)

Woodcote Consulting UK NHS … Substantial new investment lifting expenditure towards European mean (from 7% to 10% of GDP) Substantial new investment lifting expenditure towards European mean (from 7% to 10% of GDP) –£56 Bn 2003 –£90 Bn 2008 –£100 Bn 2012 ? (i.e double the cash in 10 years) Where has the cash gone Where has the cash gone –More facilities –More staff –Better pay (including a significant unplanned and unjustifiable element)

Woodcote Consulting What is the NHS Not a corporate body Not a corporate body Consisting of: Consisting of: –900 legal entities (Trusts, Health Authorities, Others) –40,000 independent contracts (GP practices, pharmacies, dental surgeries, opticians shops) –1.3 million employees the (worlds 3 rd largest) –An unknown number of partners and suppliers working primarily for the NHS Works closely with many other governmental, commercial and independent sector organisation in social care, education, criminal justice, healthcare provision, supplies and research. Works closely with many other governmental, commercial and independent sector organisation in social care, education, criminal justice, healthcare provision, supplies and research. No clear boundary No clear boundary Maybe a federation Maybe a federation Probably more like a supply chain Probably more like a supply chain

Woodcote Consulting UK NHS … What’s been delivered What’s been delivered –Some improvements in outcomes and service –Some necessary infrastructure improvements and service reconfiguration –Not enough (yet?)

Woodcote Consulting Policy Approach Stick with NHS founding principles – Free at point of use – Funded out of general taxation Stick with NHS founding principles – Free at point of use – Funded out of general taxation Increase expenditure towards European mean Increase expenditure towards European mean Seek radical workforce and service modernisation Seek radical workforce and service modernisation Complete the purchaser provider split and encourage more NHS provision by non-NHS bodies Complete the purchaser provider split and encourage more NHS provision by non-NHS bodies

Woodcote Consulting Policy Elements Choice, competition and contestability Choice, competition and contestability –Practice based commissioning, payment by results, direct payments - Money follows patients –Greater involvement of the independent sector –Greater autonomy for NHS organisations Care closer to patients Care closer to patients –More services in primary care –New providers outside hospitals –Assistive technologies Workforce modernisation Workforce modernisation –Breaking down professional divides –Making better use of available skills –New classes of healthcare workers

Woodcote Consulting Policy Elements … Preventative medicine and Managed care Preventative medicine and Managed care –Keeping people healthy –Keeping the chronically ill stable and productive –Avoiding crisis interventions Better integration between health and social care Better integration between health and social care Risk Management Risk Management –Patient Safety –Negligence litigation Patient self-care Patient self-care –Patient access to records and information –The expert patient –Support for carers

Woodcote Consulting The Common Theme? A new IT Infrastructure to share knowledge, patient records, and workflows across the health care supply chain. A new IT Infrastructure to share knowledge, patient records, and workflows across the health care supply chain.

Woodcote Consulting The Commitment To provide the NHS with the IT it needs to transform the way healthcare is delivered To provide the NHS with the IT it needs to transform the way healthcare is delivered To raise NHS IT spend to 4% of NHS revenue by 2008 (from a base of 1.7%) To raise NHS IT spend to 4% of NHS revenue by 2008 (from a base of 1.7%) Equates to £30 bn over the 10 years of the NPfIT Equates to £30 bn over the 10 years of the NPfIT £6.3 bn allocated to the NPfIT in England. The biggest ever civil IT programme in the world £6.3 bn allocated to the NPfIT in England. The biggest ever civil IT programme in the world

Woodcote Consulting The NPfIT Vision To provide secure, appropriate and timely access to all those concerned with the delivery of care to an individual to relevant parts of that individuals care records where and when needed to ensure good quality and efficient care delivered in a Medico-legally robust manner. To provide secure, appropriate and timely access to all those concerned with the delivery of care to an individual to relevant parts of that individuals care records where and when needed to ensure good quality and efficient care delivered in a Medico-legally robust manner. To provide workflow management and decision support tools to support the patient’s journey along the most appropriate clinical pathway within and across organisational boundaries in a way that delivers quality care; convenient service and makes the best use of NHS resources. To provide workflow management and decision support tools to support the patient’s journey along the most appropriate clinical pathway within and across organisational boundaries in a way that delivers quality care; convenient service and makes the best use of NHS resources. To provide patients and carers with appropriate access to the information and knowledge they need to play an active role in their own care or that of the person they care for. To provide patients and carers with appropriate access to the information and knowledge they need to play an active role in their own care or that of the person they care for.

Woodcote Consulting The Plan Provide enterprise wide EHR systems covering regional health economies linked to a national spine and national services. Provide enterprise wide EHR systems covering regional health economies linked to a national spine and national services. National services to include National services to include –A new National Network (N3) –A National Care Record Service –Electronic Booking - Choose & Book –An Electronic Prescribing Service –A Secondary Uses Service (Data warehouse)

Woodcote Consulting N3 To replace the existing NHSnet with a broadband service To replace the existing NHSnet with a broadband service To support the national services To support the national services To support NHS the Intranet (nww) and NHS service (Connect) To support NHS the Intranet (nww) and NHS service (Connect) To provide the NHS with Internet access To provide the NHS with Internet access To provide WAN connections between NHS sites To provide WAN connections between NHS sites

Woodcote Consulting National Care Record Service A national spine providing: A national spine providing: –Patient demographics (PDS) –Summary EPR (PSIS) –Security services (SoS, RBAC, LRs) –Transaction brokerage service for other national services An integrated, shared patient record across local (regional) health economies An integrated, shared patient record across local (regional) health economies A patient portal ( A patient portal ( A feed of pseudo-anonymised data to the SUS A feed of pseudo-anonymised data to the SUS

Woodcote Consulting Choose and Book To support the creation of a fully bookable NHS To support the creation of a fully bookable NHS To support electronic referrals by GPs To support electronic referrals by GPs To support patient choice To support patient choice Eventually to enable patients to book electronically in to front line services (GP practices etc) Eventually to enable patients to book electronically in to front line services (GP practices etc)

Woodcote Consulting Electronic Prescription Service Enabling prescription to flow electronically from primary care prescribers to pharmacies and the reimbursement agency Enabling prescription to flow electronically from primary care prescribers to pharmacies and the reimbursement agency –To enhance safety –To improve convenience and efficiency (particularly in relation to repeat prescribing and repeat dispensing) –To populate prescribing records on PSIS

Woodcote Consulting Secondary Uses Service To create a data warehouse of pseudo- anonymised NHS data for management and research proposes To create a data warehouse of pseudo- anonymised NHS data for management and research proposes Eventually drawing its data from the NCRS but initially absorbing legacy systems (NWCS, HES) Eventually drawing its data from the NCRS but initially absorbing legacy systems (NWCS, HES) Initial priority is to support Payment by Results Initial priority is to support Payment by Results

Woodcote Consulting Progress to Date N3 well established N3 well established QMAS added to national services and 100% rolled out QMAS added to national services and 100% rolled out Initial implementation of EPS and C&B in place Initial implementation of EPS and C&B in place Single system approach abandoned in the south and diluted in the north Single system approach abandoned in the south and diluted in the north GP system choice confirmed GP system choice confirmed

Woodcote Consulting Progress to Date …. NCRS focus now on national summary record, but not implemented yet. NCRS focus now on national summary record, but not implemented yet. Little impact on acute EPR provision Little impact on acute EPR provision Provision of PACS systems added and rolling out Provision of PACS systems added and rolling out National service added and rolling out National service added and rolling out GP2GP record transfer service added and in pilot GP2GP record transfer service added and in pilot SUS absorbing pre-existing services but no feed from NCRS yet SUS absorbing pre-existing services but no feed from NCRS yet

Woodcote Consulting Future Direction Further redefinition and refocusing of CfH aims and objectives likely Further redefinition and refocusing of CfH aims and objectives likely Likely continuing shift from homogeneous to heterogeneous model. Enterprise system to Enterprise Architecture (SOA) Likely continuing shift from homogeneous to heterogeneous model. Enterprise system to Enterprise Architecture (SOA) Slow progress to NCRS with greater focus in integration of existing systems Slow progress to NCRS with greater focus in integration of existing systems

Woodcote Consulting Issues Are the issues in the health care domain unusually complex? Are the issues in the health care domain unusually complex? Is the NPfIT trying to solve the right problem? Is the NPfIT trying to solve the right problem? Are either the right problem or the one that the NPfIT is trying to solve solvable? Are either the right problem or the one that the NPfIT is trying to solve solvable? How will issues of patient consent and confidentiality be resolved? How will issues of patient consent and confidentiality be resolved? How do you effectively combine world class IT skills with healthcare domain expertise? How do you effectively combine world class IT skills with healthcare domain expertise? Will the Government deliver on its 4% commitment Will the Government deliver on its 4% commitment

Woodcote Consulting Some Parting Facts Over a million critical process occur in the NHS every day Over a million critical process occur in the NHS every day 50-75% of healthcare cost are incurred in the last year of life (99% in the last 10 minutes if you are lucky) 50-75% of healthcare cost are incurred in the last year of life (99% in the last 10 minutes if you are lucky) 10% of hospital admissions result from deliberate self- harm 10% of hospital admissions result from deliberate self- harm 10% of patients treated will be seriously unintentionally harmed by the NHS. This leads to suffering, disability and death and costs the NHS 2bn pa in extra hospital costs. Negligence claims settled in 2003/4 cost £423 m with a total provision for outstanding claims in excess of £2 bn 10% of patients treated will be seriously unintentionally harmed by the NHS. This leads to suffering, disability and death and costs the NHS 2bn pa in extra hospital costs. Negligence claims settled in 2003/4 cost £423 m with a total provision for outstanding claims in excess of £2 bn

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Woodcote Consulting Ewan Davis Chairman - BCS Primary HealthCare Group Vice Chairman – Intellect Healthcare Group Director - Woodcote Consulting Ltd