Or Whither NHS net

Why?  Long personal involvement  Central to all the changes that surround us  Knowledge is power  Pretending it isn’t going to affect us is not an option

Why?  Not for coding clerks. –Who don’t have a long term future.  Not just for the IT department.  For us all, clinical workers and management workers alike.

What?  The NHS plan.  Information for health Our LIS. Our local funding.  Building the information core. Jan  Other bits from all over.

Strands in All This  Communications  Records  Information

Strands in All This  Maybe money?

New Ways of Working  Not bolting computers onto existing practices  About redesigning work  Redesigning care  New pathways in the jargon

NET Targets Secondary care Clinical and support staff;  25% have desktop access by now –Really is 20% ‘ish  100% by 2002 Primary care GPs and managers  95% practices connected by now –Really is 80% ‘ish  90% desktop access by now –Really 50% ‘ish  All 100% by 2002 But but but but but !

Uses Now   Net browsing  Information source  Fax out (doesn’t work!)  NSTS (not that reliable!)  Reading the stuff the NHSe no longer publishes – cures insomnia.  National address book?  GP registration links.  GP IOS links – for the brave.

Security  Lags behind  Caldicott –Awareness –Safe havens etc etc  National audit scheduled for Dec 2001 –To BS7799  NHS cryptography –Roll out spring 2002 –Public key encryption

What Next? – Uses of NHS net  National priorities are pathology requests and reports.  Then xray reports and requests.  Booking.  Discharge information.

Jargon EPR  Electronic Patient Record –? AttainableEHR  Electronic health record –? Holy grail

Clinical Terminologies  Coding viz classifications  Read 3 –Ends 2003  SNOMED – CT –Starts 2003  ? Legacy coding and classifications

EPR Level 3  Integrated patient master index. PAS. Departmental systems (all departments)  Electronic clinical orders and results reporting.  Prescribing software.  Multi-professional care pathways.

EPR – Primary Care  RFA99 legalises electronic records.  RFA99 roughly equates with levels 4-5 of secondary care EPRs.  Big problem is hospital letters. –? Scanning. –? EDI. ? 90% of practices by 2003

EPR – Primary Care  Integrated nursing and medical EPRs are coming.  National framework expected in Sept  End of many Korner MDS expected in next month or two.  Local initiatives already underway.

EPR – Out of Hours  National programme  To make summaries of GP EPRs available 24 hours a day  First to GP out of hours services  Then to A+E departments  ?? 2005

EPR – Mental Health  Separate plans for mental health EPR.  Separate funding stream.  Integrated social and health records.  Shared with social services.  25% by 2003 ?  Locally ahead of the game.

EPR – Acute Hospitals  Weird set of levels defined by the NHS  35% of acute trusts to have a level 3 EPR by 2002  100% by 2005  Plenty of words and management speak out here – few systems!

Local Status  9 practices have full desktop NHS net connection.  All practices should be connected by end of year.  16 practices have new LANs.  6 practices “paperless.”  5 practices going “paperless.”

Local Status  FHN has connection.  FHN has too poor a LAN for full desktop access.  We have started a project for pathology reporting and requesting.  We hope to add in radiology soon.  Networking information sources is proceeding.

Information  NICE  NeLH  Protocols  Policies  Guidelines  HiMPs  CHiMPs And uncle tom cobbly….

Payroll and HR  A national payroll and HR system is planned to start rolling out in  Doing away with individual organisational arrangements.

Caveats  Knowing that nurses share the same records and can rapidly communicate with doctors will allow more task sharing, profoundly changing the nature of medical work.

Caveats  A lush information landscape where information is shared with patients leaves some things unknown:  If 1% of patients join the worried well?  Sharing all records with patients?

Caveats  How much extra time to spend capturing and structuring records?[1] – 30 minutes plus per day. –[1] Tierney et al JAMA 1993;269:

Caveats  Are we ready to share our information with patients ? –The strategy says there are irresistible arguments for this.

Caveats  Control  Governance  Accreditation (and Re- )  Performance related pay  Politics Or just my depixol dose is late.

A Personal Hope Clinical Needs Not Technology for its own sake