1. Durham and Darlington ICRS Where to start?

2. Dr Grant Kelly BMA Council Chair, BMA ITC Chair DoH EPB – now: Privacy Enhancing Technologies Project SEAG of GPRD Chichester GP 21 years

3. Background 1 NWN 1994 “All patient data is to be accessible to the wider NHS family, and all those in contract with the NHS”

4. 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”

5. 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

6. 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

7. What’s the aim? To replace paper by electronics for: Speed Ease of use Availability Reliability Added value And with a net gain ….tough

8. Paper Needs no power Available (?) Universally understood/useable Law, business of supply, etc Standards in place Public acceptance/handling …but

9. But: Illegible Gets lost/de-structured Available in one place only Is passive Not a learning/auditing medium ………..time to move on

10. Non-negotiables…. Availability Ease of use Minimise consultation damage/Heisenberg Confidentiality Integrity Authenticity Non-repudiation

11. 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

12. What’s out there? ? What we’d like……

13. DVLA HASS Partners GPs Data Store PH Trusts MH EPR

14. MH Partners GPs PH Trusts SS HA

15. Clinical teams and information Patient-present needs Patient-absent needs Definitions for clinicians

16. Integrated… Joined together Federated Conforming despite time & space Appears to work as one to the user

17. ‘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

18. ‘Remote’ care Planning Information organisation Booking Referrals Dispensing Pathology etc.

19. Records 1 The abstracted knowledge about a person that enables efficient, accurate and appropriate care to be given to them

20. Records 2 Demographics History Wishes Disasters/Successes Warnings Consent Consent to publish etc

21. Service Providing this to quality standards Providing this to technical standards The provision of derived added value

22. Hurdles Who agrees the scope? Scope creep The different views Procurement & testing (solutions) Legacy staff & kit Maintaining local apps Integrity/Authenticity/Privacy/Consent

23. More than just a record